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ESQUIROL ON INSANITY. 



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MENTAL MALADIES. 



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TREATISE ON INSANITY. 



BY E. ESQUIROL, 



PHYSICIAN-IN-CHIKF OF THE IMAISON ROYALE DES ALtCNCS DE CHARENTON, FORMERLY 

INSPECTOR-GENERAI. OF THE UNIVERSITY, MEMBER OF THE ROYAL 

ACADEMY OF MEDICINE, ETC. 



d'eromthSiiench, wi 
BY E. K. HUJNT, M. D. 



TRANSLATED FROM THSWRENCH, WITH ADDITIONS, 



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PHILADELPHIA: 
LEA AND BLANCHARD 

1845. 





Entered according to the Act of Congress, in tiie year 1845, 

By lea & BLANCHARD, 

In the Clerk's Office of the District Court of the Eastern District of Pennsylvania. 



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L. MBBH.IAM, PRINTER, 
GREENFIELD, MAS3. 




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TEANSLAXOR'S PREFACE.. 



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The writings of Esquirol have long been regarded by those most competent 
to decide upon their merits, of high authority on all matters pertaining to 
insanity. In addition to a sound and vigorous intellect, improved by long and 
close application to study ; his habits of order and systematic observation, 
together with his vast experience, offer to the reader of his work, a sure pledge 
of accuracy and extent of research, as well as valuable philosophical deduc- 
tions. 

No one at all conversant with the subject on which he treats, will fail to 
observe, that he speaks from the abundant stores of practical knowledge ; 
every thought which he expresses, and every suggestion that he makes, carry- 
ing with it the force of truth, and the evidence of profound investigation. It 
will be noticed that he is extremely cautious in his statements, plain and pre- 
cise in his account of cases, and avoids, for the most part, all theoretical spec- 
ulations. In his treatment, he will be found judicious, and more active than 
the majority of French practitioners. Judging from the whole tenor of his 
work, as well as from examples, furnished at intervals throughout its pages, 
the reader will justly infer, that in relation to the moral regimen of the insane, 
" the law of love" is that to which our author yields his assent, and that which 
reigns in those Institutions over which he has presided. 

On both these interesting and important topics, the translator has briefly, 
though he believes fully enough, expressed the views, so far as known, of the 
profession in this country. With respect to several other points, brief, yet 



vi translator'spretace. 

free comment has been made, as well for the purpose of elucidating truth, as 
for that of expressing the views, at present prevailing on this side the Atlantic. 

All that portion of this Treatise, relating properly to insanity, has been 
published entire ; the remainder, referring, for the most part, to the statistics 
and hygiene of establishments for the insane, together with the medico-legal 
relations of the subject, have been omitted ; as they would only serve to in- 
crease the size and expense of the volume, without adding materially to its 
intrinsic value. 

The translation has been made, with the intent to furnish to the public and 
profession, a faithful and accurate rendering into our own language, of the 
opinions, sentiments and practice, of one who had no superior in the depart- 
ment to which he devoted his life. For those errors, whether of " omission 
or of commission," which may appear, the translator claims only that measure 
of courtesy, which may be fairly accorded to undertakings of this character. 

E. K. HUNT. 
Hartford, February, 1845. 



CONTENTS OP THE VOLUME, 



INSANITY. 



GENERAL DESCRIPTION OF THE MENTAL CHARACTERISTICS OF THE INMATES 
OF AN INSTITUTION FOR THE INSANE. 

Symptoms of Insanity. — Definition of term. — [Farther definitions from eminent 
writers.) — Illustrations. — Primitive type in some of the passions. — Vital forces often 
greatly exalted. — Physical and moral sensibility modified or changed. — Divisions of 
Insanity into lypemania, etc. — (Remarks upon.) — Causes of Insanity. — Climates, 
seasons, age, se.x, temperament, professions, modes of living, laws, civilization, mo- 
rals and political condition of a people. — Progress of Insanity. — Traced in a general 
manner, succeeded by details respecting its terminations, etc. — Prognosis of Insani- 
ty. — Considered with reference to its divisions. — Treatment of Insanity. — Isolation, 
and treatment at home, compared and considered at length. — Effects of isolation upon 
the brain. — Moral therapeutics highly esteemed. — Principles of physical treatment. — 
Site suited to the insane. — Clothing, bedding, diet, drinks, corporeal exercises. — 
Medical treatment. — Use of water. — Evacuants, purgatives, emetics, blood-letting. — 
Tonics and sedatives. — General regimen. — Counter-irritants. — Electricity, galvanism, 
magnetism. — Prophylactics. — {Farther remarks on treatment.) 19 — 91 



HALLUCINATIONS 



Definition of, by Esquirol, Sauvages, Sagar, Darwin and other English physicians. 
— Illustrative cases, with treatment. — Post-mortem examinations. — Farther raBiarks 
on hallucinations. — How accounted for. — Distinction between hallucinati«a'^' 8om- 
nambulism, and ecstasy. — The convictions of the minds of the hallucinate^ entire, 



Vlll CONTENTS OF THE VOLUME. 

and their acts in accordance with them. — Case of a Jewess; post-mortem examina- 
tion of. — Seat of hallucinations. — Darwin's and Foville's opinions respecting. — Sub- 
jects to which hallucinations usually relate. — Very common in insanity. — By some 
regarded as synonymous with vision. — How it differs therefrom. — Remarks on gene- 
ral treatment. 03 — 110 



ILLUSIONS OF THE INSANE. 

Preliminary remarks. — Illusions, by some authors confounded with hallucinations. 
— Distinction pointed out. — Illusions, not uncommon when in a state of health. — 
Examples. — Hypochondriacs suffer from them. — Three conditions necessary for the 
correct perception of a sensation. — Remarks on the causes of illusions. — Divided 
into ganglionicillusions, and illusions of the senses. — I. Examples of the former class. 
— Post-mortem examinations. — II. Examples of the latter class. — Proof that illu- 
sions depend upon the anormal action of the extremities of nerves. — Cases. — Inflam- 
mation or other lesion of the nervous centre or its membranes, often give rise indi- 
rectly, to illusions. — Conclusion. Ill — 119 



FURY. 

Definition. — Causes hemorrhages, convulsions, apoplexy and death. — Aspect of 
countenance in a state of fury. — Confounded with mania by the ancients. — Rage, 
definition of. — Fury appears in all forms of mental alienation, and even dementia. — 
Sanguine and bilious-nervous temperaments predisposed to fury. — By what caused. 
— Not in general automatic. — Usually intermittent. — Fury sometimes terminates in 
dementia, and sometimes is the last link in the chain of circumstances that affect its 
cure. — Furv renders the prognosis in mental alienation more favorable than its op- 
posite. — It may be so intense as to create danger. — Treatment, witii important re- 
marks. 121 — 123 



MENTAL ALIENATION 

OF THOSE RECENTLY CONFINED, AND OP NURSING WOMEN. 

Preliminary remarks.— Subject divided into two parts.— Part Firsf.— Temporary 
delirium of early confinement briefly noticed. — Nearly one twelfth of the women at 
the Salpetriere became insane after confinement — More among the wealthy insane 
after confinement ; among the poor after weaning. — History of this form of insanity. 
— Period of the first appearance of insanity in 92 cases, succeeded by several impor- 
tant deductions.— Symptoms accompanying an attack.— Form of insanity affecting 



C O N T E N T S O F T H E V O L U M E . " IX 

92 cases. — .^ge during which women are most subject to this malady. — Illustrative 
cases. — Is the suppression of the milk, the cause or effect of insanity .' Does the 
milk act as a foreign body in those accidents which follow confinement or lactation.' 
Opinions of both ancients and moderns on these questions. — This class of cases ge- 
nerally cured, unless the predisposition is too energetic. — How produced. — Duration 
of attacks. — Relapses. — Mortality. — Remarks on post-mortem examinations. — Gene- 
ral treatment. — Part Second. — Cases, with treatment in detail ; together with an ac- 
count of certain post-mortem examinations. 125 — 143 



EPILEPSY. 



Synonyms and symptoms. — Medium duration and frequency of attacks. — Lunar 
influences. — Notices of the leading mental peculiarities in 339 cases of Epilepsy. — 
Vertigoes epileptic, their effect upon the mind. — Pathognomonic characteristics of 
Epilepsy. — Causes. — Organs upon which they primarily act. — Analysis of post-mor- 
tem examinations. — Diagnosis. — Divisions and subdivisions. — Feigned epilepsy. — 
Prognosis. — Remarks preliminary to the details of treatment. — Attacks often lessen- 
ed temporarily in frequency by a change of remedies. — Treatment, with notice of 
numerous remedies employed in ancient and modern practice, with their effects. — 
Fear as a curative agent. — Hygienic influences. — Traveling. — Music. — Moral influ- 
ences. 145—171 



CRITICAL TERMINATIONS OF INSANITY. 

General remarks on the doctrine of crises. — No cure without a crisis. — Causes of 
incompleteness of crises. — The physician the minister of nature. — Remarks on re- 
lapses. — A marked remission usually during the first month. — Its cause. — Insanity 
terminates by resolution. — Principle of cure illustrated by cases. — Terminates by the 
predominance of activity in the absorbent system. — Terminates by great prostration 
and emaciation. — Example. — A febrile movement often serviceable. — Examples. — 
Hemorrhages sometimes eflfect a cure. — Examples. — Herpetic eruptions sometimes 
cure insanity. — Examples. — Furuncles sometimes critical in insanity. — Examples. — 
Abundant suppurations, whether spontaneous or provoked, sometimes terminate insa- 
nity. — A variety of illustrations and examples. — Influence of coition and continence. 
— Examples. — Pregnancy and confinement sometimes terminate insanity. — Exam- 
ples. — Pregnancy and confinement, when they effect a cure, act rather as exceptions 
than in accordance with a general rule. — Dentition as a cause of insanity. — Exam- 
ples. — Crises of insanity arranged in their order. 173 — 198 

o 



CONTENTS OF THE VOLUME 



LYPEMANIA OR MELANCHOLY. 

Definition of tei'm, both ancient and modern, wfth remarks. — No advancement in 
science or the arts, which has not served as a cause of mental disease. — Monomania 
has its seat in the heart of man. — A disease especially of civilization. — Modified by 
state of society. — Illustrations. — Tristimania of Rush, lypemania or melancholy of 
Esquirol. — Views of the ancients respecting melancholy. — Symptoms of lypemania 
OR melancholy. — Description of the person of a lypemaniac. — Cases. — Great torpor 
of the secretions. — Aversion to food. — Loss of rest in consequence of hallucinations 
and illusions. — Dieams terrify many. — Secretions become greatly disordered. — Urine. 
— General description of the emotions of the lypemaniac. — Modifying influence of 
the passions on the mind. — Causes of lypemania. — Seasons and climates. — Spring 
and summer produce the greatest number of lypemaniacs. — Table illustrative. — 
Spring most favorable to the cure of lypemania. — Age. — Childhood. — Adolescence. 
— Maturity. — Old a ge. — Table of ages. — Sex. — Temperaments. — Professions and 
mode of life. — Table of causes. — Lypemania is continued, remittent, or intermit- 
tent. — Remittent form most common. — Crises very numerous. — Diseases which 
CAUSE the death OF LYPEMANIACS. — Post-mortcm examinations. — Most frequent 
termination, phthisis pulmonalis. — Pathological anatomy has taught us nothing posi- 
tive, respecting the seat of melancholy. — Table of diseases to which lypemani- 
acs succumb. — Displacement of the transverse colon frequent. — Interesting case and 
post-mortem examination. — Other cases with autopsies. — Table of the pathologi- 
cal LESIONS FOUND IN THE POST-MORTEM EXAMINATION OF ONE HUNDRED AND SIXTy- 

eight CASES OF LYPEMANIA. — TREATMENT OF LYPEMANIA. — It may be hygicnic, 
moral or pharmaceutic. — Influence of atmosphere on health and disease. — Case, re- 
ported in the language of the suff'erer, together with the advice given. — Clothing. — 
Food. — Exercise both of body and mind recommended and enforced. — Isolation. — 
Tepid baths. — Continence and sexual intercourse. — The passions. — Fear. — Supersti- 
tion. — Love. — Means used to break the chain of morbid feelings. — Examples. — Mu- 
sic. — Physical treatment. — Laxatives, and at the commencement of an attack, emetics 
and emeto-cathartics. — Tartrate of Antimony and Potassa with drastics, to be em- 
ployed under certain circumstances. — The rotatory machine. — Blood-letting, local 
and general. — Baths; tepid, vapor and cold. — Aff'usions. — Douche. — Internal exhibi- 
tion of cold water. — Opium. — Magnetism. — Closing remarks. — {Farther remarks on 
treatment.) 199—233 



DEMONOMANIA. 



Origin, history and signification of term. — Origin of religious melancholy.— Stellar 
and lunar influence. — Influence of the doctrine of the Platonists on mental aliena- 
tion. — Origin of conjurations, sorcery, magic, witchcraft and astrology. — Influence 
of Christianity on the form and treatment of insanity. — The eff'ect of the reforma- 
tion of Luther and Calvin. — Mode of dissipating the errors which led to this form 
of insanity. — Analysis of symptoms of this malady, compared with those that attend 
other forms of melancholy. — Case. — Post-mortem examination. — Cases. — Sometimes 
epidemic. — Examples. — Demoniacal possession rarely occurs before puberty. — Wo- 
men more subject to this disease than men. — Causes, physical and moral. — Its access 



CONTENTS OF THE VOLUME. XI 

generally sudden. — Demonomaniacs usually emaciated, etc. — Exhale a strong odor. 
— Ecstasies common, and modified by various circumstances. — Demonomaniacs sutler 
from hallucinations and illusions. — Case. — Tenacious of their delusions. — Examples. 
— Tests of demoniacal possession. — Death often hailed with joy by the possessed. — 
Convulsions not uncommon. — Important conclusions. — Suicide much to be feared in 
this form of insanity. — Of all insane persons, lypemaniacs are the most cruel. — 
Treatment. — Medical. — Moral. — Zoanthropy. — Lycanthropy. — Fatalists, or believers 
in destiny. — Several strange views referred to. — Examples, with a post-mortem ex- 
amination. 235 — 252 



SUICIDE. 

Origin of term. — Ancient philosophers not agreed with respect to the appreciation 
of this act. — Legislation with respect to it. — A variety of circumstances lead man to 
terminate his existe^. — The impulse of lofty sentiments, — false popular views, — 
national usages, — passions, — febrile delirium and mania, — hypochondria and lypenia- 
nia. — Suicide provoked by the p.\ssions. — When strongly excited, always pro- 
duce disturbance in the organism or understanding of man. — Acute and chronic. — 
Examples of acute suicide, with remarks. — Chronic suicide. — Remarkable exam- 
ples. — Suicide preceded by homicide. — Mental condition previous to, and after 
an act of homicide described. — Form which precedes homicide, usually acute, some- 
times chronic. — Examples, and development of important principles. — Reciprocal 
suicide. — Examples. — Disposition sometimes feigned. — Examples and treatment. — 
Climates, seasons, age and sex, considered as causes of suicide. — Climates 
one of the proximate causes, but less active than morals, civilization, etc. — Table of 
quarterly admissions at the Salpctriere of those who had attempted suicide. — Most 
frequent during the warm seasons. — Hereditary. — Examples. — Most frequent when. 
— See table. — Children sometimes victims of suicide, from vicious education. — Old 
age rarejjf exposed to suicide. — Examples. — Less frequent among women than men. 
— Data establishing proportion of suicides between men and women. — Excep- 
tions. — Sometimes epidemic. — Cause. — Preventive. — The reading of immoral and 
licentious books tends to suicide. — Description of chronic suicide only given. — At- 
tempts usually voluntary. —Often great'insensibility. — Examples. — Instruments which 
suicides employ. — Great precaution used by some, to render their attempts effective. 
— Several cases with treatment. — Vanity, and a spirit of revenge sometimes 
manifested in this act. — Illustrations. — Various considerations prevent those who de- 
sire death, from the commission of suicide. — Case illustrative. — A frightful persever- 
ance manifested in some cases. — Suicide is acute or chronic ; continued or intermit- 
tent. — Examples. — Pathological lesions observed among suicides. — Opinions 
of Gall, Home, Recamier, Loder and others. — Post-mortem examinations. — Note 
from M. Leuret. — Query respecting the influence of the organs of digestion in the 
production of suicide. — Treatment of suicide: means of preventing it. — Mo- 
ral influences, with examples. — A specific treatment recommended by some. — Bleed- 
ing. — Tonic. — Bark in combination with a narcotic or sedative agent. — Cold bath. — 
Copious draughts of cold water and an issue over the liver. — Abundant corporeal 
and pleasant mental exercise. — (^Farther remarks on Treatment.) — Constant watchful- 
fiess on the part of those who have the charge of persons suffering from a suicidal 



Xll CONTENTSOFTHEVOLUME. 

propensity, indispensable. — Restraining apparatus not to be relied upon. — Should 
sleep in public halls under the constant watch of an attendant. — {Remarks on.) — 
Success of this measure at the Salpetriere. — Mode of dissipating a repugnance to 
food in the early stages of insanity. — Fear sometimes employed as a restraining 
agent. — Is suicide a criminal act .'' — Can it be prevented or lessened by legislation .'' — 
Remarks, etc., on the writings of Doct. Burrows. — Suicides greatly increased with- 
in the last half century. — Relative proportion of suicides in Paris and Berlin com- 
pared. — Proportion of men and women. — Proportion of either sex who have availed 
themselves of certain modes of committing suicide. — Researches of M. Guerry on 
suicide. — Summer produces more suicides than autumn. — Greatest number commit- 
ted between the hours of four and six, and least, between two and four, in the morn- 
ing. ^53 — 317 



MONOMANIA. 



Distinctive characteristics of monomania and lypemania. — Intellectual monoma- 
nia. — Reasoning mania of authors, affective monomania of Esquirol. — Monomania 
without delirium, or instinctive monomania. — The physiognomy and leading mental 
qualities of the monomaniac and lypemaniac described and contrasted. — Course of 
monomania more acute, and its termination usually more favorable than lypemania. — 
Theomaniacs. — Melancholica enthusiastica. — Delusions of monomaniacs. — Case in 
detail, with post-mortem examination. — Case in which hypochondria first, then lype- 
mania, and lastly monomania were successively developed. — Cases illustrating cer- 
tain mental peculiarities.— Case of Mad'e de R., with post-mortem examination. — 
Monomania sometimes epidemic. — Jl modern example. — Predisposing and exciting 
causes. — Remittent or intermittent. — Progress sometimes rapid and violent. — Termi- 
nates suddenly and unexpectedly. — Sometimes passes into mania, or alternates with 
lypemania. — When prolonged, degenerates into dementia. — Intermediate state. — 
General treatment. — Farther remarks on treatment. — Erotic monomania. — Erotoma- 
nia defined. — Distinguished from nymphomania and satyriasis. — Case illustrating the 
uncomplicated characteristics of erotic delirium, with treatment. — Mode of detect- 
ing it in its earliest stage. — Cases illustrative of its sudden and fatal termination. — 
Suicide one of its terminations. — Amorous lypemania complicated with mania. — 
Examples. — Erotomania may degenerate. — Cannot be confounded with hysterical 
madness. — Has existed among all people. — Causes of erotomania the same with mo- 
nomaniain general. — Is the cerebrum or cerebellum the part aff'ected in erotomania.' — 
In some cases, marriage almost the only remedy. — Reasoning monomania. — Gene- 
ral description, succeeded by numerous examples. — Has an acute and chronic course. 
— Three periods recognized in it. — Remittent or intermittent. — No therapeutic indi- 
cation different from what is found applicable in other forms of monomania. — Pecu- 
liar management of the mind requisite. — Reasons offered for studying it with care. — 
Monomania from drunkenness. — Fermented drinks common to all people. — Use 
and abuse. — Their effects. — Intemperance sometimes hereditary. — Sometimes pro- 
duced at the critical period in women. — Examples. — Cologne water preferred in 
some cases to other stimuli. — Paroxysmal. — Reasons assigned for the formation of 
this habit. — Tonics proposed for some cases, oil of turpentine for others. — Incendi- 
ary MONOMANIA. — (Pyroinania of Marc.) — Causes which lead to it. — Examples. — 



CONTENTS OF THE VOLUME. . Xlll 

An instinctive impulse independent of the will sometimes leads to incendiarism. — 
Inferences from foregoing cases. — Farther remarks, with respect to causes. — Relative 
proportion of male and female incendiaries. — Hygienic influences relating to sexual 
development in France and Germany described. — Enquiries respecting the age and 
sex of incendiaries. — Homicidal monomania. — Synonyms. — Causes which lead to 
it. — Mania without delirium. — Maniacal fury. — Further exciting causes. — Examples. 
— All periods of life subject to attacks. — Usually periodical. — Treatment like that of 
other forms of monomania. — Cases, with treatment and observations. — Cases of three 
little girls, with remarks. 319 — 376 



MANIA. 

Description of the maniac, and his end unless restored. — Definition of Mania. — 
Mania briefly contrasted with Monomania and Lypemania. — Views of Heinroth 
and Prichard with respect to the connection between mania and fury. — Most frequent 
causes of mania. — Table of ages. — Table of professions. — Causes. — Tables of physi- 
cal and moral causes. — Incursion of mania. — Symptoms. — Hallucinations. — Sensa- 
tions perverted. — Case in detail with treatment. — Other cases. — Mania usually chro- 
nic. — Continued, remittent or intermittent. — Sometimes alternates with other dis- 
eases. — Examples. — Critical terminations. — Table of cures. — Table of cures relative 
to seasons. — Table of the periods of mortality. — Remarks. — Post-mortem examina- 
tions. — Remarks upon.— Treatment. — Three periods characterize mania; treatment 
of each. — Restraint. — Food. — Pinel's cases with treatment.— Intercourse of physi- 
cian with patient. — Visits of friends. — Convalescents. — Views and feelings of conva- 
lescents. — Their treatment. — Remarks on medication. — Medicines appropriate to 
the first stage. — Pinel's remarks on blood-letting. — Baths. — Cold to head. — Laxa- 
tive drinks. — Enementa. — Exercise. — Diet. — Critical efibrts to be managed cautious- 
ly. — Case illustrative. — Classification, its importance. — Quinine in intermittent ma- 
nia. — Reasons for its occasional failure. — Treatment adapted to cases which result 
from the suppression of habitual evacuations. — Case. — Benefit of cold affusions, 
with cases. — Purgatives. — Camphor. — Opium. — Digitalis. — Bath of surprise. — Sub- 
mersion. — Rotatory machine. — Moxas. — Actual cautery. — Cases illustrating its ef- 
fects. — Cups. — {Farther remarks.) 377 415 



DEMENTIA. 



Definition of term. — Description of the mental manifestations of a demented per- 
son. — Physical characteristics. — Paralytic complications. — Dementia, acute or chro- 
nic, simple or complicated ; continued, remittent or intermittent. — Compared with 
mania and monomania.— Cases illustrative of the decline from mania and monoma- 
nia, to dementia. — Distinction between dementia and imbecility and idiotism. — Signi- 
fication of term insensate:— lis causes, complications, terminations and changes which 
post-mortem examinations reveal.— Influence of age.— Table of ages.— Exciting 
causes of dementia.— Table of CAUsEs!^^^Pl7ysical and moral causes.— Remarks on 
the causes of dementia.— Varieties and complications of dementia.— Maladies to 
which the demented succumb, etc.— Table of the principal organic lesions.— Extend- 



XIV CONTENTS OF THE VOLUME. 

ed description of the condition of the contents of the great cavities, as revealed by 
post-mortem examinations. — Illustrative cases. — Remarks with reference to the above 
cases. — Acute dementia. — Causes. — Invasion. — Treatment. — Termination. — Illustra- 
tive case. — Chronic dementia. — Causes. — Course. — Treatment and termination. — 
Third variety. — S enile dement ia. — Cause. — Progress. — Treatment and termination. 
— Complicated varieties. — Complications. — Incurable. — Invasion gradual. — E.xtreme 
limits of this disease, usually from one to three years. — Phenomena of the last period 
of life. — Cases. — Comparative frequency of paralysis connected with dementia in 
different countries. — Several authors cited on this point, German, Italian and Eng- 
lish. — Pathology and periods, as indicated by Bayle. — Symptoms of paralysis usually, 
indicative of a fatal termination. — Sometimes existing very early in an attack of 
insanity. — Cases. — Delirium sometimes ceases, while the paralysis persists. — Case. — 
Practical considerations. — {^Brief extracts from other writers icith reference to the 
paralysis sometimes connected with dementia.) 417 — 444 



IDIOCY. 

Brief account of the views of authors in regard to idiocy. — Synonyms. — Origin 
and signification of term. — Commences with life. — Idiots never reach an advanced 
age. — Vices of conformation almost invariably discoverable in brain. — Dementia and 
idiocy contrasted. — Illustrative cases. — Idiots classed in two divisions, viz., imbeciles 
and idiots. — Contrasted. — First variety. — Imbecility. — General description of im- 
beciles. — Cases, together with admeasurements of the head. — Remarks respecting 
habits and mode of life of imbeciles. — A few whose minds are capable of partial 
development. — Their gayety, piquant repartees, jovial manners, etc., have been the 
means of their introduction to the great. — At Court even is there the post of fool. — 
Origin of custom. — Employed by rogues for culpable purposes. — Acts to which pu 
berty gives rise. — Second variety. — Idiocy. — Idiots incapable of speech — Case of 
Queneau, with post-mortem examination. — Other cases, describing the figure, admea- 
surements of the head, habits, and peculiar characteristics of idiots. — Moral and phy- 
sical condition of the mothers of idiots, while pregnant with them. — Account of 
cases representing the extreme limit of idiocy from Pinel, Gall, and the records 
of the Salpetriere. — Idiots nearly or quite deaf as well as mutes. — The senses null 
or exceedingly obtuse. — Comparative view of the condition of the blind and dumb, 
and idiots. — Remarkable aptitude of many idiots for the acquisition of music, and 
their fondness for musical sounds. — Deductions from the above cases. — A number of 
the physical and predisposing causes noticed. — Exciting causes of idiocy. — Volume 
and form of the heads of idiots. — Gall's limits of intelligence. — Researches of Fo- 
ville, Parchappe and others, respecting the vices of conformation in the cranium of 
the idiot, and its development compared with that of the health}' subject. — Table of 
mean results of certain cranial admeasurements. — Remarks of Morgagni and Meckel 
respecting the cerebral substance in idiocy. — Malacarne, on the convolutions, etc., of 
the brain in idiocy. — Remarks of Lavater and Camper respecting physiognomy of 
idiots. — Remarks on treatment. — (Brief account of some recent attempts to improve 
the condition of idiots). — Cretins, Cagots and Albinos. — Cretinism. — Origin and defi- 
nition of term. — History of Cretinism. — The person of the cretin described. — Like 
idiots, cretins may be divided into three classes. — Description of first class. — The 
first, the most numerous class. — Description of second class. — Of third class. — Cre- 



CONTENTS OF THE V^OLU ME. XV 

tins not necessarily born such. — Organism develops very slowly. — Relative propor- 
tion of cretins and idiots. — Examination of the crania of idiots obtained with great 
difficulty. — (Description of one belonging to Dr. H. A. Grant, of Hartford, Conn.) — 
Opinions of authors respecting the causes of cretinism various. — Views of several 
authors noticed. — Opinion of M. Bayle in respect to the influence of water in the 
production of cretinism. — Opinion of M. Vyn. — Immediate cause as obscure as the 
predisposing and remote. — Opinions of authors respecting. — Probable cause, the 
influence to which infants are subjected. — Do cretinism and goitre depend upon the 
same cause .^ — Cretinism diminishing. — Causes assigned. — Albinos. — Definition of 
term, and description of the person of albinos. — Usually found in connection with 
the goitrous and idiotic. — Born of parents of every variety of complexion. — Intel- 
lectual and physical characteristics. — Natives of all countries. — Synonyms. — Testi- 
mony of ancients respecting albinos. — Characteristics, physical and intellectual, of 
the parents of albinos. — History of Roche. — Cagots. — Signification of term. — Pro- 
vincial appellations of — Degradation of those wretched beings for centuries, ex- 
treme. — Considerations with respect to savage races of men. — Conclusion. — Cases in 
illustration of the history of idiocy, giving an account of the mental and physical 
condition of idiots, together with a description of their physiognomy, and daily 
habits. — Several autopsies. 445 — 496 






%. 



'S 



Isf 



P E E r A C E . 



The work now offered to the public, is the result of forty years' study and 
observation. I have noticed the symptoms of insanity, and have studied the 
manners, habits, and wants of the insane, in the midst of whom I have passed 
my life. I have also tried the best modes of treatment. Confining myself 
to facts, I have arranged them according to their relations. I have stated 
them as they have been observed, without, in general, attempting to explain 
them ; and have avoided systems, which always appeared to me more seduc- 
tive by their splendor, than useful in their application. 

The materials of this work, collected at the Salpetriere, at the Hospital at 
Charenton, and in my private practice, have been successively published in 
the Dictionary of Medical Sciences, and other medical works. 

While, as it respects principles, they remain the same, many of these ma- 
terials have been subjected to various modifications, and drawn out into more 
detail, in order that they may more perfectly harmonize with my later obser- 
vations. Some of these have been translated into various languages, and 
published by German, and Italian Physicians ; and I trust that the result of 
all my labors, which I have reviewed with the greatest care, and now publish 
for the first time, will be favorably received by medical men. 

Most highly do I appreciate the advantages of a work, systematically ar- 
ranged ; and without doubt, my book would be read with more interest, if a 
general idea pervaded all its parts. But it would engage me in a labor, in- 
compatible with my numerous avocations : nevertheless, we shall find a me- 
thodical connection, in the distribution of the materials of which it j^ com- 
posed. ...".-r 

The first Chapter, entitled Insanity, is a summary of the sent|Qiigpts preva- 
lent on this subject; the remaining ones, are commentaries, jpi *more full 
exposition of these views. . - '^.,'' 



XVlll PREFACE. 

Having taken part in the earliest efforts that were made to ameliorate the 
condition of the insane, I have aided in their fulfillment, both by my writings, 
my teachings, and travels. 

Happy shall I be, if this new publication, notwithstanding its imperfections, 
may contribute to overcome prejudices, to dissipate errors, to throw light upon 
obscure points connected with mental diseases, and to make known truths, of 
useful application in the treatment and regimen, of that unfortunate class, to 
whom I have devoted my life. 



MENTAL DISEASES. 



ESSAYS ON INSANITY AND ITS VARIETIES. 



INSANITY. 

GENERAL DESCRIPTION OF THE MENTAL CHARACTERISTICS OF THE INMATES 
OF AN INSTITUTION FOR THE INSANE. 

Symptoms of Insanity. — Definition of term. — (Farther definitions from eminent writers.) 
— Illustrations. — Primitive type in some of the passions. — Vital forces often greatly 
exalted. — Physical and moral sensibility modified or changed. — Divisions of Insanity 
iiito lypemania, etc. — (Remarks upon.) 

Causes of Insanity. — Climates, seasons, age, sc.x, temperament, professions, modes of 
living, laws, civilization, morals and political condition of a people. — Progress of In- 
sanity. Traced in a general manner, succeeded by details respecting its tertninations, 
etc. — Prognosis of Insanity. — Considered with reference to its divisions. — Treatment 
of Insanity. — Isolation, and treatment at home, compared and considered at length. — 
Efliects of isolation upon the brain. — Moral therapeutics highly esteemed. — Principles 
of physical treatment. — Site suited to the insane. — Clothing, bedding, diet, drinks, 
corporeal exercises. — Medical treatment. — Use of water. — Evacuants, purgatives, eme- 
tics, blood-letting. — Tonics and sedatives. — General regimen. — Counter-irritants. — 
Electricity, galvanism, magnetism. Prophylactics. — (^Farther remarks on treatment.) 

What reflections engage the mind of the philosopher, who, turning aside 
from the tumult of the world, makes the circuit of a House for the insane ! 
He finds there the same ideas, the same errors, the same passions, the same 
misfortunes, that elsewhere prevail. It is the Scime world ; but its distinctive 
characters are more noticeable, its features more marked, its colors more vi- 
vid, its effects more striking, because man there displays himself in all his 
nakedness ; dissimulating not his thoughts, nor concealing his defects ; lend- 
ing not to his passions seductive charms, nor to his vices deceitful appear- 
ances. 

Every House for the insane has its gods, its priests, its faithful, its fanatics. 
It has its emperors, its kings, its ministers, its courtiers, its opulent, its gene- 
rals, its soldiers, and a people who obey. One believes himself inspired of 
God, and in communication with the Holy Spirit. He is charged with the 
conversion of the world ; whilst another, possessed of a demon, given over to 
all the torments of hell, groans, and is frantic with despair ; cursing heaven, 
earth, and his own existence. Another, bold and audacious, commands th€f> 



20 INSANITY. 

universe, and makes war with the four quarters of the globe ; which he has 
subjected to his laws, or delivered over to the chains of despotism. A third, 
proud of the name he has given himself, looks with disdain upon his compan- 
ions in affliction ; lives alone, retired, and preserves a seriousness, as affecting 
as it is vain. This one, in the pride of his heart, thinks himself to possess 
the science of Newton, and the eloquence of Bossuet ; and requires the ap- 
plauses of those about him to the productions of his genius, with a comic pre- 
tension and assurance. That, stirs not ; nor makes the least movement ; al- 
ways in the same place, and in the same position, he utters not a word. We 
might take him for a statue. He lives within himself; his inaction is destroy- 
ing him. Withered by remorse, his neighbor drags out the feeble remnant of 
a life, which he with difficulty sustains. Uttering reproaches, he curses him- 
self, and invokes death, as terminating the evils that are preying upon him. 
Near him, is a man who, appearing happy and in the perfect enjoyment of his 
reason, calculates the moment of his dissolution with frightful indifference. 
He prepares with calmness, and even joy, the means of terminating his exist- 
ence. This wretched man, both day and night, with eye and ear, watches for 
secret enemies. Darkness and light, sound and silence, motion and repose, 
all frighten and terrify him ; he fears himself. How many imaginary terrors, 
consume the days and nights of this lypemaniac ! Proceeding onward, we 
see one who, believing himself betrayed, persecuted and dishonored, has be- 
come agitated, exasperated, furious. Suspicion and hatred raise up enemies 
on every hand. In his unbridled vengeance, he spares no one. Another, the 
sport of a morbid sensibility, and an excited imagination, suffers from habitual 
anger. He breaks, rends, and destroys, whatever comes within his reach. 
He cries aloud, threatens, and strikes, alledging always a motive to justify the 
frightful disorder of his actions. He whom you see confined, is a fanatic, 
who vociferates, blasphemes, and condemns to the fires of hell. He pretends 
to convert men ; and as it is by the baptism of blood that he would purify 
them, he has already sacrificed two of his children. This senseless being, 
amid the noisy ravings of his delirium, is of an incoercible petulance. He 
would injure no one, though ready, apparently, to commit the greatest disor- 
ders. To witness his eager activity, you would believe that some great sub- 
ject engaged his attention, and that his destiny depended upon his movements. 
In his devious course, he shocks and offends every one that surrounds him, and 
overthrows whatever opposes his progress. He follows and assails you with 
his unintelligible babble ; but notwithstanding this torrent of words, he says 
nothing, thinks nothing. 

Another, quite at his ease, passes a happy life, laughing incessantly : yet 
who can excite his joy, and for what can he hope ? He has no recollection 
of the day just past, nor any desire for the morrow. 

Thus, in a House for the insane, one can hear at the same time, the shouts 
of gladness mingled with sentiments of sorrow ; expressions of joy, in connec- 
tion with the groans of despair. He may see contentment in some, and tears 
flowing from the eyes of others. 

In these establishments, the social bonds are broken ; habits are changed ; 
friendships cease ; confidence is destroyed. Their inmates do good without 
benevolence ; injure without dislike, and obey through fear. Each has his 
own ideas, affections, and language. With no community of thoughts, each 
lives alone, and for himself Egotism isolates all. Their language is ex- 
travagant, and disordered, like the thoughts and passions which it expresses. 
An asylum of this character is not exempt from crime. They denounce, ca- 
lumniate, conspire. They give themselves up to brutish libertinism ; ravish, 
rob, assassinate. The son curses his father, the mother strangles her children. 

If we proceed farther, we see man, fallen from the high rank which places 
him at the head of creation, despoiled of his privileges, deprived of his most 



INSANITY. 21 

noble character, and reduced to the condition of the most stupid and vilest 
creature. He thinks not. Not only is he destitute of ideas and passions, but 
has not even the determinations of instinct. 

Unable to provide for his subsistence, he is also incapable of conveying to 
his lips the aliment that tenderness or benevolence provides. He rolls about 
amid his own ordure, and remains exposed to all external and destructive in- 
fluences ; rarely recognizing his fellow beings, and having no proper senti- 
ment of his own existence. In this assemblage of enemies, who know only 
how to shun, or injure each other ; what application, what devotion to duty, 
what zeal are necessary, to unfold the cause, and seat of so many disorders ; 
to restore to reason its perverted powers ; to control so many diverse passions, 
to conciliate so many opposing interests; in fine, to restore man to himself! 
We must correct and restrain one ; animate and sustain another ; attract the 
attention of a third, touch the feelings of a fourth. One may be controlled 
by fear, another by mildness ; all by hope. For this untiring devotion, an ap- 
proving conscience must be our chief reward. For what can a physician 
hope, who is always considered wrong when he does not succeed, who rarely 
secures confidence when successful ; and who is followed by prejudices, even 
in the good which has been obtained. 

For our guidance, in this chaos of human miseries, we will reduce to four 
principal divisions, what we have to say concerning insanity : 1st, we will ana- 
lyze the symptoms which characterize this malady ; 2d, seek for its causes ; 
3d, trace its progress, and mark out its different terminations ; 4th, and final- 
ly, we will lay down the general principles of its treatment. 



I. SYMPTOMS OF INSANITY. 

Insanity, or mental alienation, is a cerebral affection, ordinarily chronic, and 
without fever ; characterized by disorders of sensibility, understanding, in- 
telligence, and will. 

I say ordinarily, because insanity is sometimes of brief duration ; and be- 
cause at its commencement, and sometimes during its course, febrile symp- 
toms are manifested. 

[Few, if any systematic writers on the subject, have omitted to furnisli a definition of 
the term " insanity." 

After a lengtiiy, and able description of the faculties of the mind, in their healthy and 
disordered manifestations, Conolly has given us his definition in the following language : 
" Insanity is the impairment of any one or more of the faculties of the mind, accompa- 
nied with, or inducing a defect of the comparing faculties." 

Pritchard, after a cursory notice of the sentiments of earlier writers on this point, des- 
cribes insanity " as a chronic disease, manifested by deviations from the healthy and na- 
tural state of the mind, such deviations consisting either in a moral perversion or a dis- 
order of the feelings, aff'ections, and habits of the individual, or in intellectual derange' 
ment, which last is sometimes partial, namely in monomania, affecting the understanding 
only in particular modes of thought ; or general, and accompanied with excitement, 
namely, in mania, or raving madness ; or lastly, confounding or destroying the connec- 
tions or associations of ideas, and producing a state of incoherence." 

Doct. Brigham, superintendent of the New York State Lunatic Hospital, has recently 
given us the following : " Insanity is a chronic disease of the brain, producing either de- 
rangement of the intellectual faculties, or prolonged change of the feelings, aifections 
and habits of an individual." 

In general, it is regarded as a disorder of the system, by which the sound and healthy 
exercise of the mental faculties is impeded and disturbed. 



22 INSANITY. 

That every case of mental derangement, from the first moment of its existence, can 
be perceived, and referred with accuracy and precision to one or another of these defini- 
tions, just as in science every fact may be referred back to its principle, is not, by those 
at all conversant with the subject, supposed to be in all, or perhaps in any case, possible. 

Who can tell when health ends and disease begins ? When disease is found to have 
shed its blighting influence over the system, is it possible, after establishing this fact, to 
decide what amount or kind is necessary to occasion aberration of mind, and when this 
amount and quality is developed ? When developed, does it at once manifest its baleful 
influence upon the brain, by producing insanity ; or does it not rather brood over the 
delicate organ of the mind, and gradually fulfill its dread commission ? When again the 
mind begins to totter, and reason to sit insecurelj' upon her throne, do the friends and 
acquaintances of the unhappy sufferer recognize these first monitions ? Or do they not 
rather behold, — if indeed they observe any thing, — a simple change of habit, slightly 
perverted moral feelings, or trifling eccentricities of character ? 

Now it is conceived to be quite possible, not to say probable, that even during this 
early stage of insanity, before the friends or immediate associates of the patient are 
aware of its existence, or before it becomes developed to a degree that brings it clearly 
within the limits of any of the above definitions, that a source of excitement — fear, ap- 
prehension, or mental disturbance of some sort — shall so operate upon the mind, through 
the medium of its diseased organ the brain, as to lead the person so afflicted, now to the 
commission of suicide ; now to homicide, or other acts of a grossly immoral and highly 
criminal character. , 

Experience also justifies the belief, that these results may follow in the train of excite- 
ment occurring from ordinary intercourse with society; and equally, from the perverted 
thoughts and emotions of the individual — thoughts and emotions too, which he may 
never have expressed, or merely hinted at, in conversation with his friends. 

If this be true, and we firmly believe it is, how extremely difficult may it be, to sepa- 
rate the acts, whether criminal or otherwise, of the man who feigns insanity, and Jiim 
whom God has seen fit, in his providence to afflict.' 

How utterly inapplicable, and useless indeed in emergencies of this sort, are the most 
elaborate and subtle definitions of this term "insanity"! Time, and time alone, will 
enable us satisfactorily to distinguish between them. 

No skill of the physician, no degree of experience however great, no penetration or 
reach of thought, will suffice at a glance to decide this momentous question. 

Careful observation of the bodily health, and particularly those organic functions that 
are beyond the control of the will ; and watchfulness by day and by night, to as great an 
extent as possible, of the mental operations and acts of the patient — and that without his 
knowledge or suspicion of the fact — will eventually and rightfully decide the case. 

Such are a few of the general considerations, by which we are to be governed in our 
attempts to detect and decide upon the existence and form of insanity, from which a 
fellow being may suffer. 

Yet, as if to baffle all our efforts, and to render nugatory the best concerted plans for 
its detection, a form is known to exist which is strictly intermittent in its character; the 
patient in the intervals, furnishing not the remotest evidence of insanity. Then again a 
progressive derangement may form a sort of crisis amid the horror and confusion of some 
dread outbreak, which shall compromise if not terminate the existence of a human 
being, and with it the insanity which led to the lamentable result. The crisis of a 
child's grief and pain often manifests itself in sobs and tears; of anger, in a brawl or 
fight ; in a word, of any strong emotion, in a powerful and concentrated exercise of it. 

Insanity, when it assumes this form, is to be studied successfully, only by a careful 
examination of all the facts and circumstances of the case, as they are unfolded previ- 
ously to, and many times, long before the outbreak which renders it painfully evident, 
as well as during its manifest existence and subsequently.] 



INSANITY. 23 

Among the insane, sensibility is exalted, or perverted ; and their sensations 
are no longer in relation with external or internal impressions. They seem to 
be the sport of the errors of their senses, and of their illusions. Many insane 
persons do not read, because the letters appear to be mingled in a confused 
mass, so that they are unable to arrange them, in such a manner as to form 
syllables and words. A thousand illusions of sight, produce, and continue 
their delirium. They recognize neither their parents nor friends, and regard 
them either as strangers or enemies. They are no longer correct in the ap- 
preciation of the qualities and properties of surrounding objects ; many be- 
lieving themselves at their usual places of abode, when, indeed, they are very 
far removed from them, and reciprocally. 

An officer of talent, of strong constitution, and about forty-six years of age, 
experiences some disappointments in the service. He becomes irritable, is re- 
manded to Paris, and is not received as he had anticipated. His imagination 
becomes excited. After some days, he leaves his own residence at eleven 
o'clock in the evening, traverses the Place Louis XV., and finds not the Co- 
lumn, elevated in the Place Vendome. He at once persuades himself that the 
insurgents have overturned it, and threaten the government. He stations 
himself upon the bridge Louis XVL to defend the passage again.st the pre- 
tended insurgents. He arrests all who would pass. The guard appear. He 
contends desperately ''gainst these enemies of the State, is wounded, and yields 
only to numbers. 

A lady aged twenty-seven years, in the last stage of phthisis, becomes ex- 
ceedingly annoyed by the odor of burning charcoal. She believes that they 
wish to suffocate her ; accuses the proprietor of the house, and hastens to de- 
nounce him to her friends. This odor follov.s her every where. Every where 
she is assailed by the fumes of charcoal. She quits her lodgings, changing 
them many times in a month. The principal disease continues to make pro- 
gress, and the patient dies, tormented to the last by her hallucination. 

Very often the insane repulse with horror, and obstinately refuse aliments 
after having smelled them for a considerable time. Frequently, at the com- 
mencement of insanity, the taste is perverted ; and the alienated reject all 
kinds of nourishment. This symptom, alarming to those who have no ex- 
perience among the insane, is dissipated with the inconvenience which causes 
it, viz., gastric irritation. 

A student breakfasts with a friend, gets tipsy, becomes furious, and remains 
convinced that they have mingled drugs with his wine. (See Ulusinns). 

How frequently do the insane deceive themselves with respect to the 
volume, form, and thickness, of those bodies which they touch ! The 
greater part become unskillful in labors of the hands, in the mechanic arts, 
music and writing. They are very awkward, and the touch has lost its sin- 
gular property of rectifying the errors of the other senses. 

These errors of sensation appear to affect, sometimes but one sense, often 
two, more rarely three, sometimes four, and even all. When mental aliena- 
tion manifests itself, and sometimes long before, both the senses of smell and 
taste are altered, but errors of hearing and sight, characterize, and continue 
more generally, the delirium of the greater part of the insane.* 

There are insane persons who hear voices speaking very distinctly, and with 
which they hold successive conversations. These voices proceed from the 
clouds, and from trees ; they penetrate walls and pavements ; they pursue 
and fatigue, those who hear them, d;iy and night ; while walking, in society, 
amidst assemblies, as well as in retirement. They take the accent and tone 
of a relative, a friend, a neighbor, or an enemy. They make proposals, gay, 
erotic, threatening or injurious in their nature. They advise to actions, con- 
trary to honor, to interest, or to the preservation of the patient. A gentle- 

* See Hallucinations and Illusions. 



24 INSANITY. 

man, after a dreadful catastrophe, thinks himself accused ; attempts suicide, 
and passes more than two years, in listening to the threatening voices of his 
accusers. 

Mrs. A. entertains the belief that men enter her chamber d\ix^a^ the 
night. On being shown that this is impossible, she replies, they pass through 
the lock. A lypemaniac speaks aloud, when by himself, and as if in conver- 
sation with another person. I remarked upon its impropriety, assuring him 
that no person could hear, or reply to him. In the midst of our discussion, he 
says to me : Do you not sometimes think? Doubtless, I replied. You think 
silently, he continued, but 1 aloud. If insanity is characterized and maintain- 
ed by errors of sensation, by illusions and hallucinations ; it is also, by the 
multiplicity of sensations, by the abundance of ideas, the versatility of the 
affections, which are produced in melancholy confusion, without order, end, 
or coherence. This exuberance of thought, permits not the patient to arrest 
his attention sufficiently long upon each sensation or idea, to separate those 
which have no relation among themselves, or to remove those, which exist in 
excess. He can no longer seize upon the qualities or relations of things ; 
neither compare, nor abstract. There results from this disposition a volatile 
delirium, whose object is unceasingly renewed, and takes every variety of 
form. Both the language and actions participate in this mobility, and give 
at times, a very elevated, and even sublime character, to the thoughts. Un- 
der other circumstances, the attention exercises itself with so much energy as 
to become fixed upon a single subject. Constantly confined to this, nothing 
can turn it aside. All reasonings and determinations, are derived from this 
all-absorbing idea. Monomania offers a thousand examples of this form of 
delirium. 

The faculty which the mind possesses, of associating our sensations and 
ideas, of arranging them among themselves, of combining them with our de- 
terminations, presents very remarkable alterations among the insane. The 
slightest impression, or the most remote coincidence, provokes the strangest 
associations. 

The city of Die is overlooked by a neighboring rock, which is called the 
U. A young man suggested to himself the propriety of adding the letter U 
to the word Die, making it the word Dieu, (God). Hence all the inhabi- 
tants of Die, became gods in his opinion. He immediately perceives the ab- 
surdity of this Polytheism, and concentrates the divinity in the person of his 
father, as the most reputable man of that country. His father, although at 
two hundred leagues distance acts in him, and he acts only by his father. A 
general becomes agitated, cries aloud, and takes the tone of a commander, 
the moment that he hears the drum or the cannon. Often the delirium allies 
itself so closely to the cause which has excited it, to the intellectual and mo- 
ral condition of the patient at the period of the attack, that this vicious asso- 
ciation, persists during the whole disease, characterizes it, and becomes the 
only obstacle to its cure. An emigrant soldier, thirty-five years of age, 
having returned to France, is arrested, put in prison, and loses his reason. 
Restored to liberty, he sees himself every where surrounded by spies, and 
agents of the police. 

A young artist, a passionate admirer of Rousseau, not obtaining the first 
prize for sculpture, of which he thought himself deserving, gives himself up 
to despair. He vows eternal hatred to men, and wishes no longer to live, 
except after the manner of brutes. He walks upon all fours, and if placed 
upon a bed rolls himself off upon the ground. If confined, he has convul- 
sions. He will eat nothing but herbs, or crude fruits which he picks up from 
the ground. If helped to them, he refuses to use them. This condition per- 
sists for more than two months, after which he fidls into a state of dementia, 
to which h^ has a strong predisposition, having several brothers and sisters 
affected wito tJiis form of disease. 



■ '•'-'•V 

INSANITY. 25 

With another class of the insane, the enfeebled organs perceive but feebly, 
sensations ; impressions are not sufficiently felt ; memory retains them not, 
and is unfaithful. These persons remember only events long since passed. 
Impeffectly served by their sensations and memory, they cannot seize upon 
affinities. They can no longer arrest their attention, as it is not excited by 
the impression of external objects. Their determinations are uncertain. 
They seem to act only from recollections. 

Memory presents also striking anomalies among the insane, the ideas either 
requiring an actual sensation to awaken them, or a continual effort to recall 
them. Memory is not wanting with these patients, but the faculty of direct- 
ing and fixing their attention being impaired, memory serves them imper- 
fectly. 

In some cases of mental alienation, man, deprived, in some sort, of the 
control of the will, seems no longer to be master of his determinations. The 
insane, controlled by their predominant ideas and impressions, are drawn 
away to the performance of acts which t-hey themselves disapprove. Some, con- 
demning themselves to repose, to silence and inaction, cannot control the 
power which represses their activity. Others walk about, sing, dance, and 
write, without the power to refrain. We have seen some escape from their 
relatives with no other motive than the desire of moving about, hasten from 
point to point for many days, scarcely stopping to take nourishment ; while 
others give themselves up to acts of madness, which cause them intense agony. 
These impulses, these irresistible propensities, these automatic determinations 
as authors call them, seem to be independent of the will. However, they re- 
sult generally, from motives, of which the insane, and those conversant with 
them, can, to a certain extent, give an account.* 

The insane are, as Locke remarks, like those who lay down false principles, 
from which they reason very justly, although their consequences are errone- 
ous. 

A public receiver, after long and difficult labor upon the finances, is strick- 
en with mania. The attack terminates in melancholy complicated with de- 
mentia and paralysis. He refuses for some days to drink at his repasts. 
They insist — he becomes enraged ; exclaiming, rascal, would you have me. 
swallow my brother ! Reflecting upon this strange notion, I perceive that 
the patient sees his own image in the bottle placed upon the table. I remove 
it, and from thenceforth he drinks without difficulty. A vine-dresser slays 
his children, says Pinel, but he does it that they may not be damned. A 
woman forty years of age, having ftiUen into the most abject misery, throws 
herself into the river. She assured me that during twenty-four hours, while 
walking upon its banks, she had suffered indescribably, and had resolved upon 
suicide, only to prevent the anguish of the most profound misery. 

The moral affections provoke insanity. The symptoms which characte- 
rize it, impress often, every feature of the passions. The determinations 
which the passions produce, are not in harmony with those by which the 
patient was formerly affected, nor with what are observed among other indi- 
viduals. 

A madman is passionate, jealous ; he commits murder. He is impatient of 
restraint ; and if he cannot otherwise escape, will precipitate himself from 
the house in which he is confined, or set fire to it. Among the insane, some 
are stricken with terror, believe themselves ruined, tremble lest they shall be- 
come the victims of a conspiracy, fear death. Others are happy and gay ; 
think only of the good which they fnjoy, or of the benefits which they can 
dispense. They feel persuaded that they are elevated to the greatest* dignity, 
— that the homage of the world is their due, — that they inhabit a superior re- 

*" See Homicidal Monomania. 



26 INSANITY. 

gion, where they are eternally to dwell, intoxicated with delight. Witness, for 
example, the madman of Athens, who believed that all the vessels entering the 
Pyraeus were his own. 

A young chemist, aged twenty-seven years, and of a strong constitution, labors 
night and day in researches appropriate to his department. He becomes 
greatly excited, and is at the same time amorous. He precipitates himself 
from the fourth story of the house, and fractures the fibula. Replaced in bed, 
the delirium continues intense. The patient distributes millions, and promi- 
ses that all the world shall be happy. At the expiration of three months he is 
restored. 

The first sentence which he wrote his parents is thus expressed : ' / fiel 
that I imtst renounce my illusions. Never shall I he so happy as during the 
three months which have just passed.' This happy state of some deranged 
persons, has been the cause of many errors respecting this class of people. 
Some who see them thus, conclude that the insane are all hapj)y, that they do 
not suffer ; whilst, generally, they suffer as much physically as morally. 

The passions of the insane are impetuous, especially in mania and mono- 
mania. They are of a depressing character in lypemania. In dementia and 
imbecility, those only exist, which spring from the first wants of man, — love, 
anger, jealousy. 

He who should say that rage is but an attack of anger prolonged, might 
also say, that erotomania is love carried to excess, — that religious lypemania 
is zeal or religious fear carried beyond due limits, — that suicide is an attack 
of despair. Thus, from a condition the most calm, one becomes excited, by 
insensible gradations, to the most violent passion, and even to the most furious 
mania, or sinks into the profoundest melancholy, — almost all forms of insani- 
ty, having their primitive type in some of the passions. 

The insane sometimes surrender themselves to the most disgraceful acts. 
Here is one of strict integrity, of irreproachable morals, connected even 
with the highest class in society ; but who, becoming insane, makes infamous 
proposals, indulges in indecent gestures, and is the opposite, in every respect, 
to what his past conduct would lead us to expect. 
There are, in fine, those who rob. 

M. ***, forty years of age, after the storms of the revolution had passed 
away, returns to France and obtains an honorable subsistence. Two years 
subsequently, he suffers from loss of memory, and his friends perceive a 
change in his character. At length, while dining with one of them, he car- 
ries off certain pieces of silver plate. On arriving at Paris, he betakes him- 
self to the cafe de Foy, orders a cup of chocolate, breakfasts, and leaves with- 
out paying, carrying oft' in his waistcoat, a spoon and saucer. It is unneces- 
sary to relate here, the excesses which the hysterical and nymphomaniacs 
commit. 

The insane become pusillanimous in the extreme. They permit themselves 
to be easily intimidated. They are fearful, difiident, jealous. It is this which 
occasions their restlessness, which makes them anxious to be any where, rather 
than where they happen to be, — to distrust themselves, and to withdraw fi-om 
their parents and friends. This feeling of distrust, is found among people of 
little intelligence. Men the least suspicious, and the most confident, are, be- 
yond contradiction, those who cultivate their minds ; so true is it, that moral 
force is in proportion to mental development. But notwithstanding this dis- 
trust, the insane are improvident, to a degree which can be compared only 
with that of savages. They have no care for the moment which has just past, 
but are extremely anxious for the present. This improvidence exposes them 
to privations of every kind, if a careful watch is not exercised over them, and 
their wants carefully supplied. 

The insane often entertain an aversion towards persons who were previous- 



INSANITY. ^27 

ly dear to them. They i'nsuU, misuse, and fly from them. It is a result, how- 
ever, of their distrust, jealousy and fear. Opposed to all, they fear all. Some, 
appear to constitute an exception to this general law, and seem to preserve a sort 
of affection for their relatives and friends. But this tenderness, which is some- 
times excessive, exists without confidence, and without intimacy with those 
persons, who, before their illness, directed the ideas, and actions of the pa- 
tient. This melancholic person adores his wife, but is deaf to her advice and 
prayers. This son would sacrifice his life for his father ; but would do no- 
thing through deference to his counsels, from the moment they have his de- 
lirium for their object. 

This moral alienation is so constant, that it would appear to me to be an 
essential characteristic of mental alienation. 

There are insane persons whose delirium is scarcely noticeable ; none whose 
passions and moral affections, are not disordered, perverted, or annihilated. 
The return of the moral affections within their just bounds, the wish to see 
his children and friends once more, the tears of sensibility, the desire of un- 
folding the affections, of finding himself again in the midst of his family, and 
of returning to his accustomed habits, are certain signs of a cure ; while the 
contrary had been a sign of approaching insanity, or the index of a threaten- 
ing relapse. 

The diminution of delirium is a certain sign of returning health, only 
when the insane return to their first affections. 

Closing this long summary of the intellectual and moral symptoms of in- 
sanity, let us pass to the principal physical alterations, which the insane pre- 
sent. 

The vital forces acquire, among this class of persons, an exaltation which 
permits them to resist influences, most calculated to affect the health ; but 
this exaltation is not so general as is commonly believed. 

Examples are rare, though repeated on all sides. Some insane persons ex- 
perience an internal heat, so intense, that they throw themselves into water, 
and even amid ice, or refuse all clothing at the coldest season of the year. 

With others the muscular system acquires an energy, the more formidable, 
as force is joined to audacity, and their delirium renders them indifferent to 
danger. 

We have seen madmen pass many days without food or drink, and pre- 
serve all their muscular energy. I repeat it, these examples are rare. Al- 
most all the insane crowd around the fire when there is occasion for its use, 
and almost all eat much, and very frequently. 

Scrofula aflfects so many of the insane in every hospital, because their 
habitations are damp, cold, and imperfectly ventilated : and because this class 
of patients live in idleness and inactivity. Epidemics and contagions spare 
them not, which proves that they are not so insusceptible to external influ- 
ences as is pretended. 

The features of the insane are convulsed, and their physiognomy wears the 
impress of pain. How different the changeful features of the maniac ; the 
fixed and lengthened visage of the melancholic; the relaxed features, and ex- 
tinct expression of one in dementia, from those of the same individuals after 
restoration to health ! 

Among the insane, some are plethoric, others Ivmphatic ; some are strong, 
others feeble ; the pul.se is full, voluminous and hard among the former ; with 
the latter, slow, soft, and concentrated. Tormented with hunger and thirst, 
they are more agitated or melancholic after, than before their repasts. Some 
have acid nidorous eructations ; some debility of the stomach, which induces 
them to drink wine and liquors ; while others suflfer from abdominal pains, 
and heat of the intestines. 

Maniacs, monomaniacs and lypemaniacs, do not sleep ; insomnia conti- 



28 INSANITY. 

nuing for several months. Tf they sleep, they have the nightmare, frightful 
dreams, and are awoke by surprise, vi^hiie imbeciles and those in dementia 
would like to sleep constantly. 

There are those, who are troubled with a constipation, which persists for 
eight, thirteen and twenty-one days, — those whose urine is retained for twenty- 
four, sixty, and one hundred and twenty hours. With others, the alvine de- 
jections and urine, pass off involuntarily. 

All the secretions acquire a penetrating odor, impregnating both the cloth- 
ing and furniture, and which nothing can remove. 

Many insane persons suffer from violent pains in the head, which cause them 
to beat it ; also from pains in the chest, abdomen and limbs, which they attri- 
bute often, to their enemies, to the devil, or to harsh treatment. In fine, they 
are subject to cutaneous affections, sores, hemorrhoids, convulsions, organic 
diseases, etc. 

From all that precedes we conclude, that among the insane the vital proper- 
ties are changed ; that physical and moral sensibility ; the faculty of perceiv- 
ing, comparing and associating ideas ; the memory and will ; the moral affec- 
tions, and the functions of organic life ; are all more or less impaired. 

As I have interdicted myself from all explanation, I must content myself 
with saying, behold the facts. However, I will add a few brief observations, 
which will aid, perhaps, in shedding some light on the subject of delirium. 

A young man sees around him all the persons composing the court. He 
prostrates himself before the feet of him, whom he believes to be the sovereign, 
and refuses the attentions they are about to render him ; unwilling to be serv- 
ed by such august personages. He becomes furious, when the servants treat 
with familiarity the sovereign of his creation. I cause his eyes to be bandag- 
ed for two days, and his delirium ceases ; but on removing the covering, it 
again returns. 

Reil states that a lady, seeing spectres and monsters about her, fell into a 
convulsive delirium ; and that her chambermaid, in order to protect her, plac- 
ed her hand over the eyes of the patient, who immediately exclaimed ; I am 
cured. This experiment was renewed with the same success, before the phy- 
sician. 

The insane, when restored, preserve the most perfect recollection of their 
sensations, whether true or false. They recall without difficulty their reason- 
ings, and the determinations resulting from them, and the recollection even, 
of the smallest details, acquire distinctness, as they advance towards the en- 
joyment of perfect health. Hence during delirium, they possess the know- 
ledge and capacity requisite for reasoning. 

As to lesions of the understanding, they can be reduced to that of the at- 
tention ; Jean Jacques has said, " The state of reflection, is a state, contrary 
to nature. 3Ian who meditates is a depraved animal." Instead of this misan- 
thropic freak of thought, Rousseau should have said, that all reasoning sup- 
poses an effort, and that we are not naturally reasoning beings ; that is to say, 
our ideas are not conformed to objects, our comparisons exact, our reasonings 
just, but by a succession of efforts of the attention ; which supposes in its 
turn, an active state of the organ of thought ; just as a muscular efibrt is ne- 
cessary to produce motion, although the movement may no more exist in the 
muscle, than thought in the brain. 

If we reflect upon what passes through the mind of even the most sensible 
man for a single day, what incoherence shall we notice in his ideas and deter- 
minations, from the time that he awakes in the morning, until he retires to 
rest at night ! His sensations, ideas and determinations, have some connec- 
tion among themselves, only when he arrests his attention ; and then only does 
he reason. The insane, no longer enjoy the faculty of fixing, and directing 
their attention', and this privation is the primitive cause of all their errors. 



INSANITY. 29 

We observe this among children, who, although very impressible, have ne- 
vertheless kw sensations, for want of attention. The same thing happens to 
the aged, because their attention is no longer solicited by external objects, in 
consequence of the feebleness of organs. 

The impressions are so fugitive and numerous, the ideas so abundant, that 
the maniac cannot .fix his attention sufficiently upon each object and idea. 
With the monomaniac, the attention is so concentrated, that it cannot turn 
itself aside upon surrounding objects, and accessory ideas. Hence these mad- 
men feel, but do not think. Among those in a state of dementia or the con- 
trary, the organs are too much enfeebled to sustain the attention, and there 
are no longer sensations or understanding. 

The attention of all the insane is so essentially disturbed by one of these 
three causes, that if sensation, strong, agreeable, painful or unexpected, fixes 
the attention of the maniac, or turns aside that of the monomaniac ; if a vio- 
lent commotion arouses the attention of him who is in a state of dementia ; 
lie immediately becomes rational, and this return of reason, lasts as long as 
the effect of the sensation ; that is, whilst the patient retains the power of di- 
rectinor and sustaining his attention. 

Imbeciles and idiots are deprived of this faculty, and hence are incapable 
of education. I have very often repeated this experiment among them. Hav- 
inor taken casts of a great many insane people, I have succeeded in jjlacing in 
a suitable attitude, maniacs, the furious even, and the melancholic ; but could 
never cause the imbeciles to close their eyes sufficiently long for the plaster to 
flow, whatever degree of good will they might bring to the undertaking. I 
have even seen them weep, because the casting of their heads had not succeed- 
ed, and undertake many times, but unsuccessfully, to preserve the posture that 
had been given them. They were unable, also, to close their eyes longer than 
one or two minutes. 

Will the pathological study of the fiiculties of the soul, conduct to the same 
results with those to which M. Laromiguiere has arrived, in his eloquent dis- 
courses on philosophy ? 

Numerous facts will justify this psychological view, upon which reposes a 
principle, fruitful, with respect to the cure of mental diseases. 

After having reduced insanity in some sort to its elements ; after having 
isolated them ; to obtain the general forms of insanity, we have only to reunite 
these elements. Now these general forms are embraced in the terms follow- 
ing, and constitute five varieties. 

1. Lypemania (melancholy of the ancients), delirium with respect to one, 
or a small number of objects, with predominance of a sorrowful and depress- 
ing passion. 

2. Monomania, in which the delirium is limited to one or a small number of 
objects, with excitement, and predominance of a gay, and expansive passion. 

3. Mania, in which the delirium extends to all kinds of objects, and is ac- 
companied by excitement. 

4. Dementia, in which the insensate utter folly, because the organs of thought 
have lost their energy, and the strength requisite to fulfill their functions. 

5. Imbecility, or idiocy, in which the conformation of the organs has never 
been such, that those who are thus afflicted, could reason justly. 

[The forms of insanity here given by our autlior, and which have so long been received 
and admitted by those concerned in the management of the insane, are destined at no 
distant day to undergo a decided modification, if not a radical change. 

In its relations to insanity, the mind is regarded as susceptible of two principal divi- 
sions ; namely, into an intellectual and moral portion. 

Each of these have their peculiar province, the one presiding over all operations pure- 
ly mental, the other over those involving only the feelings and emotions^ 



30 INSANITY. 

They may, under the influence of appropriate causes, each become deranged in their 
manifestations, and give rise to a form of insanity which shall involve the intellect or 
moral nature exclusively. 

A third form may result from a derangement of both of these in the same individual ; 
and thus in three divisions may be embraced all those forms of insanity of which the 
mind is susceptible. 

As sub-divisions 'however, among writers on insanity, as well as in common parlance, 
the terms lypemania or melancholy, mania or madness, and dementia, will doubtless con- 
tinue to be employed as qualifying or explanatory words in the more general descriptions 
above referred to, and with their present significations. So also in relation to monoma- 
nia, when the mental aberration is limited to a few subjects. 

Notwithstanding, the intellectual, moral and mixed will, at no distant day, become the 
leading divisions of this important subject.] 

These forms, sufficiently well distinguished in the engravings appended to 
these memoirs, in which are described the varieties of insanity, have served as 
the basis of classification with Pinel ; and express the generic characters of 
mental alienation. Being common to many mental affections, whose orio-in, 
nature, treat iiient and termination, are widely different, they cannot charac- 
terize the .-peoies and varieties which are reproduced with infinite shades of 
difference. 

Insanity may assume successively, all these forms ; monomania, mania, and 
dementia, may alternate and replace each other, and become complicated in 
the course of the same disorder, and in the person of the same individual. 

It is this circumstance, that has caused some physicians to reject all distinc- 
tions, and to admit, in insanity, but one and the same malady, which masks 
^ itself under various forms. I do not concur with them in this opinion, and 
regard the varieties of which I have just spoken, as too distinct ever to be 
confounded. 

We could wish to establish the numerical relation which subsists between 
the different forms of insanity. Some authors believe that melancholy is the 
most frequent. Pinel would seem to be of this opinion. However, in the se- 
cond edition of his " Treatise on Insanity,'' he makes si.x hundred and four 
maniacs, and only two hundred and ten melancholies or monomaniacs. 

To compare the returns which have been made in different places, and by 
different authors, it would be necessary that each should give the same signi- 
fication to the terms, dementia, idiocy, inania and melancholy ; a fact which 
does not exist. 

According to the foregoing definition of these varieties, I think that mono- 
mania is more frequent than mania. Dementia and idiocy are more rare, par- 
ticularly the latter, which is endemic in certain mountainous districts. 



II. CAUSES OF INSANITY. 

The causes of mental alienation are as numerous, as its forms are varied. 
They are general or special, physical or moral, primitive or secondary, predis- 
posing or exciting. 

Not only do climates, seasons, age, sex, temperament, profession and mode 
of life, have an influence upon the frequency, character, duration, crises, and 
treatment of insanity ; but this malady is still modified by laws, civilization, 
morals, and the political condition of people. It is, also, produced by causes, 
whose influence is more immediate, and easily appreciated. 



INSANITY. 31 

1. Climates. — Warm climates are not those which produce the greatest 
amount of insanity ; but rather temperate climates, subject to great atmos- 
pheric vicissitudes ; and especially those, whose temperature is alternately cold 
and humid, damp and warm. We see less of insanity in the Indies, in Ame- 
rica, Turkey and Greece ; more of it, in the temperate climates of the north. 

We have greatly exaggerated the influence of climate, in the production of 
insanity. Montesquieu believes, that the foggy atmosphere of England is the 
principal cause of the great number of suicides, of which the English speak 
with a kind of ostentation. We shall see farther on, that it is the most power- 
ful and immediate cause of the great amount of insanity, which we notice 
among our neighbors. It .seems to be endemic in some countries. In marshy 
districts, dementia is more frequent, and imbecility multiplies there. 

Cretinism is endemic in the defiles of mountains. Mountaineers who de- 
scend into our cities, are more exposed to nostalgia, than the inhabitants of 
the plains. 

The causes of insanity are not the same in a mountainous country, and on 
the sea-coast — in an agricultural district, and one which enriches itself by 
commerce. 

2. Seasons. — After Hippocrates, Areteus and Celsus assure us, that summer 
and autumn produce rage. Most authors state that melancholy is particularly 
severe in autumn. 

Dementia appears in winter. 

Charles VI. became insane after having been exposed to the sun at the 
chase, or while engaged in exercises preparatory to war. Were not the inha- 
bitants of Abderas stricken with insanity, in consequence of remaining too 
long exposed to the sun, while witnessing the Andromeda of Euripides? 

Dodart saw a young man who lost his senses whenever he became heated. 

The author of the Topography of Auvergne remarks, that its inhabitants 
who go into the southern provinces of Spain, return from thence melancholies 
or maniacs. Many Frenchmen, before our soldiers were acclimated in Spain, 
became insane. 

Excess of cold causes the same disorders ; a truth illustrated in the ex- 
perience of our troops during their disastrous retreat from Russia, when 
many French soldiers were seized with phrenetic delirium, and even mania. 

Doctor Pienitz, physician of the hospital for the insensate, at Pima, near 
Dresden, received many French officers who were insane. Their mania was 
acute and passed promptly into a chronic state. 

Heat, like cold, acts upon the insane, with this difierence, that the continu- 
ance of warmth augments the excitement, while cold prolongs the depression. 
Great atmospheric commotions, excite and exasperate the insane. A house 
for the insane is most disturbed, and recpiires the most carei'ul supervision, at 
the period of the equinoxes. The influence of certain winds upon the inha- 
bitants of India, the Neapolitans, and Spaniards, explains suflicit-ntly the effect 
of certain atmospheric states upon the insane. 

From the following report, kept at the Salpetriere for nine years, we learn ; 
1. that the admissions into this hospital, are most numerous during the months 
of May, June, July, and August. 2. that this proportion decreases from Sep- 
tember to December, to diminish still more in February and March. 



32 



INSANITY 



TABLE OF SEASONS. No. I. 



Months. 


Years. 


Totals. 


1806 

18 


1807 
19 


1808 
18 


1809 
13 


1810 
15 


1811 
13 


1812 
22 


1813 
26 


1814 


January .... 


18 


162 


February . . . 


23 


23 


27 


26 


13 


13 


15 


19 


14 


173 


March 


27 


27 


16 


18 


22 


17 


17 


27 


16 


187 


April 


32 


24 


15 


27 


19 


13 


28 


20 


18 


196 


May 


26 


27 


23 


26 


34 


30 


29 


31 


17 


243 


June 


32 


28 


33 


31 


22 


18 


32 


26 


29 


251 


July 


23 


37 


21 


39 


34 


24 


37 


21 


29 


265 


August 


20 


23 


25 


32 


21 


19 


29 


25 


45 


239 


September . . 


21 


24 


21 


25 


16 


25 


23 


26 


25 


206 


October .... 


23 


24 


16 


17 


18 


18 


23 


23 


26 


188 


Noveniber . . 


23 


21 


23 


27 


28 


16 


16 


19 


25 


198 


December . . 


24 

292 


19 
296 


14 
252 


18 


18 


23 


20 


25 

288 


30 


191 


Totals 


299 


260 


229 


291 


292 


2499 



The influence of the seasons extends even to the course of the insanity. 
There are individuals who pass the summer in a state of prostration or agita- 
tion ; whilst in the winter they are in an opposite condition. 

Delirium changes its character with the seasons. 

A lady, twenty-six years of age, after an attack of variola, has an abscess 
form in the arm-pit. It is opened, the wound cicatrizes, and insanity bursts 
forth. After two years the same patient is committed to my care. Her hus- 
band, at each succeeding change of season, announces the form of delirium 
about to occur, and this has been repeated, with great exactness, for several 
years. 

Insanity, which appears in spring and summer, has an acute course. If not 
speedily cured, it terminates during the winter. The monomania and mania 
of autumn, terminate only in the spring. Summer is more favorable to the 
cure of dementia. 

The cures which take place during the warm season are more rare, but 
more lasting. 

Relapses are most likely to recur, at the season of the year corresponding 
with the first attack. They are most frequent in spring and summer, although 
they may occur in winter. 

Relapses, although after an interval of many years, recur at the same sea- 
son, with perfect regularity, in certain cases of intermittent insanity. 

Does the moon exercise any influence upon the insane ? The Germans and 
Italians, believe it does. The English, and almost all the moderns, give to 
the insane, the name of lunatics. Daquin of Chamberi,* after some observa 
tions, concludes that the moon exercises an influence over this class of mala- 
dies. Certain isolated facts, and phenomena observed in many nervous dis- 
eases would seem to justify this opinion. 

I have been unable to verify this influence, though I have been at some pains 
to assure myself of it. It is true, that the insane are more agitated at the full 
of the moon, as they are also, at early dawn. But is it not the light of the 
moon that, excites them, as that of day, in the morning? 

Does not t^iis brightness produce, in their habitations, an effect of light, 
which frightens one, rejoices another, and agitates all ? 

I am conviA&ed of this last effect, from causing the windows of certain in- 



The Philosophy of Insanity; Chamberi, 1804, in 8 vo. 



INSANITY. 33 

sane persons, who had been committed to my charge, as lunatics, to be care- 
fully closed. 

Doctor Hutchinson never perceived this influence during several years, 
whilst connected with the Pennsylvania Hospital, in the capacity of Assistant 
physician. 

Haslam has not been more fortunate at the Bedlam of London. 

At the Hospital Salpetriere, where practical truths have become, in some 
sort known, among the inmates of the house, they have no longer any suspi- 
cions of lunar influence. The same is true of the Bicetre, and certain pri- 
vate houses of the capital. 

Nevertheless, an opinion which has existed for ages, which is spread abroad 
through all lands, and which is consecrated by finding a place in the vocabu- 
lary of every tongue, demands the most careful attention of observers.* 

Many authors assure us that mental alienation is epidemic. It is certain 
that there are years, when, independently of moral causes, insanity seems sud- 
denly to extend to a great number of individuals. As for moral contagions, 
they are incontestable. We shall speak of them hereafter, 

3. Age. — Infancy is secure from insanity, unless at birth, the child suffers 
from some vice of conformation or convulsions, which occasion imbecility or 
idiocy. However, Joseph Franck, found in 1802, at St. Luke's, London, a 
child, who had been a maniac from the age of two years. 

In 1814, I took charge of a child, aged eight years, of an agreeable figure, 
and endowed with the usual share of intellect, who had been very nuich fright- 
ened by its governess, at the siege of Paris, This child spoke often correctly, 
yet nothing could restrain him. He escaped frequently from his mother and 
governess, and wandered about the city. He was accustomed to descend into 
the court of the hotel, and to order the horses, pretending to be master. It 
was confidently affirmed, that he had gained a great sum, in a lottery. Does 
he visit the shop of a tradesman, or pass by a warehouse, he seizes upon the 
money that his mother or customers give, in payment for their purchases. He 
would often insult, provoke, or strike persons whom he met, especially 
those who were accustomed to visit his mother. He slept as soon as he sat 
down, and threw every thing into disorder as soon as he rose up, making a 
great deal of noise. He abused his mother, and was unwilling to do any thing 
that she desired. 

A child, nine years of age, having recovered from an ataxic fever, became 
a maniac. He was perverse, insulted his father and sisters, struck every one 
he met, often wept, was unwilling to eat, did not sleep, and was noisy. He 
was much emaciated, and affected with a relaxed state of the bowels. 

He was committed to my care, August 13th, 1814, about the eighth day 
of his new disorder. We permitted him to give a loose rein to all his desires, 
and indulged him in the open air during the whole day ; prescribed for him 
quinine, together with a tonic regimen, and in two months he was restored. 

In December, 1815, I was consulted in behalf of a child, endowed with 
precocious intelligence, aged eleven years, having a voluminous head, and very 
devoted to study. 

He was melancholic, with hallucinations of taste and vision, and had fallen 

*MM. Leuret and Mitivic, have examined the subject, with a view to ascertain whe- 
ther the moon influences the pulse of the insane; and they decide in the negative. See 
their work, entitled, '■^Frequency of the pulse among the insane," etc. in 8 vo. Paris, 1832 : 
with engravings, representing the phases of the moon, and the number of the pulsations 
of the Insane, taken daily, during a month of summer, and one of winter, at the Salpe- 
triere, and at Ivry. 

5 /'' 



34 INSANITY. 

into marasmus. He often refused to eat, wishing for no aliment, from the time 
that he saw, or thought he saw the smoke of it. 

He had assumed a tone of command and authority over his parents. 

Isolation produced the effect of diminishing his repugnance to aliments, 
without chancrinff his delirium. 

These examples, which are not altogether exceptions, if joined to those 
which are caused by the jealousy of childhood, and by masturbation from very 
early life, are notwithstanding very rare. 

It is only at puberty, during the earliest menstrual efforts, or during, and 
after a too rapid growth, that we begin to notice certain cases of mental alien- 
ation. But after puberty, we see much of erotic, hysterical and religious in- 
sanity. 

In youth, mania and monomania, burst forth in all their varieties and forms. 

Lypemania is rather the lot of adult age ; while dementia attacks those 
more advanced in years, and such as have reached the evening of life. In 
youth, insanity has a more acute course, and is terminated by more distinct 
crises. In adult age, it is more chronic, and is more frequently complicated 
with abdominal affections, cerebral hemorrhages, and paralysis. It runs its 
course more slowly, and terminates by hemorrhoids, and alvine dejections. Its 
cure, also, is more uncertain. 

It is dementia only, that is not sometimes observed among the young, and 
only mania and melancholy, that do not appear in advanced life. Greding, 
Rush, etc., have seen aged maniacs, of eighty-five years.* 

We have had at the Salpetriere, two women, aged, the one eighty, and the 
other eighty-one years, affected with maniacal fury. They were cured. I 
have attended upon a man seventy-eight years of age, who had melancholy 
complicated with mania. These persons had, however, preserved the vigor of 
consistent age. 

Mental alienation might therefore be divided, relative to ages, into imbeci- 
lity for childhood, mania and monomania for youth, lypemania or melancholy 
for consistent age, and into dementia for advanced life. 

We have only to repeat with Haslam, that among sixteen hundred and sixty- 
four insane persons admitted into Bedlam hospital, from 1784 to 1794, nine 
hundred and ten were from twenty to fifty years of age. Rush is not more 
exact, when he says, that of seventy insane persons who were in the Pennsyl- 
vania hospital in 1812, sixty-four were between twenty and fifty years of age. 

It is not surprising, that in a period of thirty years, and at a time of life too, 
when man is most exposed to every variety of disease, there should be the 
greatest proportion of insane persons. We will remark, however, that the 
number of the insane, between the ages of twenty and fifty years, is much 
more considerable, proportionally, in Pennsylvania than in London. 

Can there be in England, more idiots, and individuals in a state of demen- 
tia, than in Pennsylvania ? Hereditary predisposition, which so often leads 
to insanity in England, and morals, which exercise so great an influence in 
the production of this disease, furnish sufficient grounds for the difference 
which is known to exist. 

* Tliere is now at the Retreat for the Insane at Hartford a maniac eighty-one years of 
age. She was recently admitted. 



INSANITY. 



35 



TABLE OF AGES. No. II. 





Report kept 


at the Bicetre for ten years. 




Years. 




Ages. 




Total. 


15 


20 


30 


40 


50 


60 


1784 


5 


33 


31 


24 


11 


6 


110 


1785 


4 


29 


49 


25 


14 


3 


124 


1786 


4 


31 


40 


32 


15 


5 


127 


1787 


12 


39 


41 


26 


17 


7 


142 


1788 


9 


43 


53 


21 


18 


7 


151 


1789 


6 


38 


39 


33 


14 


2 


132 


1790 


6 


28 


34 


19 


9 


7 


103 


1791 


9 


26 


32 


16 


7 


3 


93 


1792 


6 


26 


33 


18 


12 


3 


98 


1793 


4 


36 


28 


22 


13 


10 


103 


Totals, 


65 


329 


380 


236 


130 


53 


1193 




Report kept at i 


he Salpetriere J 


^or four years. 




Years. 




Ages. 




Total. 


20 
34 


25 


30 


35 

27 


40 


50 


60 


70 


80 
4 


1811 


37 


38 


48 


38 


24 


12 


262 


1812 


52 


34 


33 


18 


38 


57 


26 


19 


3 


280 


1813 


43 


29 


33 


41 


32 


57 


31 


13 


6 


285 


1814 


42 


35 


38 
142 


31 
117 


26 
144 


53 


34 


22 

66 


10 
23 


291 


Totals, ] 


[71 


135 


205 


115 


1118 


Report of 


my own Establ 


ishment. 




86 64 43 


35 1 30 46 


15 5 3 


327 



To determine what period of life furnishes the greatest number of insane 
persons, it was sufficient to bring together the records, made up under very 
different circumstances. One of them was made at the Bicetre, where poor 
men only, are received ; another at the Salpetriere, a hospital destined for 
poor women. The last related to an establishment devoted to the wealthy. 
From these reports we may conclude : 1st, that the age which furnishes the 
greatest number of insane, is for men, that, from thirty to forty years ; whilst 
for women, it is that, from fifty to sixty years ; 2d, that the ages which fur- 
nish the least, are for both sexes, childhood, youth, and advanced age ; 3d, 
that among women, insanity appears earlier than among men indeed from 
twenty-nine to thirty years of age ; 4th, that the rich are affected, in compa- 
rison with the total number of insane persons, in a greater proportion than the 
poor.* 

4. Sex. — Ccelius Aurelianus assures us, that women are less subject to insa- 
nity than men ; and what was true in his time is still so in Italy and Greece. 
In the north of France the contrary is true ; the number of insane women 

* To determine the influence of age in the production of insanity, it is necessary to 
compare the number of insane persons at each period of life, with the whole number of 
people living, at those periods respectively. 



36 INSANITY. 

being, in that region, greater than that of men. In England, the number of 
insane men bears a more equal proportion to that of women. We find the 
reason for this difference, in the comparison of their habits. 

The vices of education adopted by our young ladies, the preference given 
to acquirements purely ornamental, the reading of romances, which o-ives to 
the intellect a precocious activity and premature desires, together with ideas 
of an imaginary excellence that can never be realized ; the frequenting of plays 
and society ; the abuse of music, and want of occupation ; are causes suffi- 
cient to render insanity most frequent among our women. 

In England, women receive a more substantial education ; they lead a more 
retired life, and do not take so important a part in public affairs. The social 
existence of men does not depend so much upon their acts or caprices, and 
hence there are less insane women than in France. 

From 1745 to 1775, Raymond found no difference in numbers, between the 
two sexes, among the insane at the hospital of Marseilles.* 

In 1786, Tenon found, that the number of insane men and women, in the 
public and private establishments of Paris, were nearly equal. t 

In 1791, the Duke de Larochefoncault Liancourt, in the excellent reports 
which he made to the constituent assembly, respecting the public charities, 
showed that a very great difference existed, between the number of men and 
women at the Bicetre and Salpetriere. 

In 1802, Pinel established the difference to be as that of one man, to two 
women, in comparing the Bicetre with the Salpetriere. 

In 1804, an examination at the establishment at Charenton, indicated that 
the men, numbered more than half of the inmates of the House. 

The men are always more numerous here, than women ; a fact depending 
upon localities, and peculiar circumstances. 

In 1807 and 1810, while taking a hasty survey of the hospitals of the prin- 
cipal cities of France, I found about 6000 insane persons ; in the proportion 
of five men to seven women. 

In 1813, the prefect of the department of the Seine ordered an enumera- 
tion of all the insane, then in the public and private Houses of Paris. He 
found the number of females, to be the greater by one quarter. 

In my establishment there were received, during twelve years, one hundred 
ninety-one men, and one hundred forty-four women. 

From 1744 to 1794, in the hospital of Bedlam among nine thousand eight 
hundred and seventy-four deranged persons, the women numbered but one 
hundred more than the men. 

The director of St. Luke's Hospital, London, being interrogated by a Com- 
mittee of the House of Commons, reported that they received annually into 
that hospital, about one third more women than men. 

At the Retreat near York, they admitted during ten years, a quarter more 
women than men. 

At the Hospital for the insensate at Vienna, there were, in 1811, one hun- 
dred seventeen men, and ninety-four women. 

At the Hospital at Berlin the proportion of men to women is as one to two. 

At the Pennsylvania Hospital, the proportion is reversed ; that is, one fe- 
male to two males. 

* Topography of Marseilles in the Memoirs of the Royal Society of Medicine, years 
1777, 1778 ; Paris, 1780, torn. II. fig. 124. 

t Memoirs respecting the Hospitals of Paris. Paris, 1788, in 4to. p. 218. 



INSANITY. 37 

TABLE OF THE SEX. No. III. 

1756. — Raymond at Marseilles, 50 men to 49 women. 

1786.— Tenon at Paris, 500 " 509 " 

1786 to 1794.— At Bedlam, 4992 " 4882 " 

1807.— At St. Luke's, 110 " 153 " 
Bicetre and Salpetriere, (mean 

year), 120 " 279 " 

Vienna, 117 " 94 " 

At the Retreat near York, 67 " 82 " 
1807 to 1812.— Several Hospitals of 

France, 488 "700 " 

1802 to 1814.— My Establishment, 191 " 144 " 



Total, 6635 6892 

In bringing together these different records, casting them up, and compar- 
ing them, we may conclude, without pretending to have arrived at a rigorous 
appreciation of the influence of sex, — 

1. That in a very considerable number of insane people, selected from dif- 
ferent countries, and in different conditions, the disparity in numbers between 
men and women, is much less considerable than is usually supposed : 

2. That this difference approaches very nearly, the proportion which exists 
between the two sexes, in the general condition of the population : 

3. That this difference is not the same in all countries : 

4. That in France the proportion of women is much greater than in Eng- 
land. 

As to the reports of other countries, they are based upon too small a num- 
ber of cases, and extend over too brief a period of time, to enable us to form 
conclusions on which we can rely, either with respect to those countries them- 
selves, or relatively, to France and England. 

Let us not imagine that this question is one of little moment. It ought to 
awaken grave reflections respecting public morals, and the influence which 
women exercise over them. Its solution ought to furnish one of the prelimi- 
nary data, in the construction of every hospital for the insane. 

Women yield to the causes of insanity, proper to their sex ; physical causes 
act more frequently upon them than men ; they become more frequently in- 
sane before the age of twenty years ; are more subject to dementia ; and their 
delirium is religious or erotic* Almost all their insanity is complicated with 
hysteria. 

Women practice during their disorder, more concealment than men, they 
speak with more repugnance of their condition, and try to hide it from them- 
selves and others. 

Men are, on the contrary, more maniacal, more furious. They are more 
frank, more confident in their delirium, which is complicated often, with hy- 
pochondria. Their treatment is not interrupted, a greater proportionate num- 
ber are cured, and they are less subject to relapses than women. 

5. Temperament. — Simple temperaments are so rarely met with in practice, 
that it is not easy to point out with precision, that of this or that individual ; 
and for a still stronger reason, that of one insane person or another. 

The sanguine temperament, constitutes one of the predispositions to mania. 
The nervous temperament, characterized by a susceptibility which every thing 

* Thomas' Essay on Women. 



38 



INSANITY. 



irritates and exasperates, in consequence of a susceptibility which deprives its 
possessor of the facuhy of reasoning, is favorable to the production of mania 
and monomania. Individuals of a dry temperament, over whom the abdomi- 
nal viscera exercise a controlling influence, who are fearful, timid and restless, 
are predisposed to lypemania. 

The lymphatic temperament may be met with in connection with mania 
and monomania, but we ought then to fear dementia. 

Imbeciles and idiots, offer no temperament, to which we can assign the cha- 
racter. 

Among two hundred and sixty-five insane persons, Haslam found two hun- 
dred and five whose hair was dark, and sixty who had light hair. 

In Pennsylvania, among seventy deranged persons, a single one had light 
hair, and fifty-six, blue or light eyes. 

Chesnut colored hair and eyes, are most frequently met with at the Salpe- 
triere, because it is the general color of these parts in the north of France. 
More than one tenth of the insane admitted, have either gray or white hair, 
by reason of their advanced age. Blue eyes are found in great numbers, in 
comparison with black ones. 



No. IV. 



External aspects of the body, 



Stature, 
Eyes, . 



Hair, 



r Moderate fullness, . . 122 

< Lean, 60 

( Fat, 6 

( Tall, 102 

} Short, 19 

f Chesnut color or brown, 102 

Blue or light color, . . 98 

Black, 17 

f Chesnut color, . . ,118 

Flaxen, 39 

<( Gray or white, ... 36 

Black, 31 

(^ Dark flaxen, .... 2 



In general, those who have black hair, who are strong, robust, and of a san- 
guine temperament, are maniacs, and furious. The course of their insanity 
is more acute, its crises more marked, than among those composing the other 
classes. Those whose hair is of a flaxen color, who have blue eyes, and a 
lymphatic temperament, become maniacs and monomaniacs ; but their insa- 
nity passes readily into a chronic state, and degenerates into dementia. Those 
who have black hair and eyes, and who are of a dry, nervous temperament, 
are more frequently lypemaniacs. Those who have red hair, are furious, trai- 
torous and dangerous. 

6. Profession, and mode of life. — Persons who devote themselves very per- 
severingly to study, who abandon themselves to the vagaries of their imagina- 
tion, who fatigue their intellect, either by a restless curiosity, or by turning 
aside in obedience to theories and hypotheses, or the allurements of specula- 
tive ideas, present a condition favorable to the development of mental aliena- 
tion. 

Some, possess an uncontrollable mental mobility ; glance at every thing, but 
are incapable of thoroughly investigating any thing. Others, take an interest 
only in certain objects, and manifest an obstinate tenacity for the same medi- 
tations and conceptions. 



INSANITY. 39 

These two classes, placed at opposite extremes, stand upon the confines of 
insanity, unless they constantly keep in check, those native dispositions. 

Dryden has said that men of genius, and the insane, stand near too-ether. 
If he meant by this, that men, who possess very active and disorderly imagi- 
nations, who have great exaltation and mobility of ideas, present striking ana- 
logies with the insane, he spoke correctly. But if he meant, that great intellec- 
tual capacity, occasions a predisposition to insanity, he is mistaken. Men of 
the greatest genius, both in the sciences and arts, the most illustrious poets, 
the most skillful painters, have preserved their reason, even to extreme old 
age. If we have seen painters, poets, musicians, and artists become insane, 
it is because they associate, with a very active imagination, great errors in re- 
gimen, to which their organization exposed them, more than other men. It 
is not because they exercise their minds, that they lose their reason ; nor is it 
the culture of arts and letters, that we are to accuse. Men, who are endowed 
with great power of thought and imagination, have special need of sensations. 
The greater part of painters also, of poets and musicians, impelled by the need 
of emotions, abandon themselves to numerous errors of reirimen ; and it is 
these, far more than excessive study, which are the true cause of their insanity. 

In other cases, the understanding takes an exclusive direction ; and the 
man meditates without cessation, upon subjects connected with metaphysical 
speculations, and confines himself to them, with a determination proportion- 
ate to the efforts that are made to divert his mind. All his physical and mo- 
ral faculties are absorbed. He neglects the most important personal atten- 
tions, condemning himself to practices which seriously affect his constitution. 

Spasms of the epigastrium, are immediately followed by inertia of the nu- 
tritive system, the digestion becomes deranged, the secretions depraved, and 
transpiration is suppressed. Hence hypochondria and melancholy ; so famil- 
iar to educated men of a meditative cast of mind, who grow pale from ex- 
cessive study by night and day. 

The danger is much greater, and far more imminent, if the attention con- 
centrates itself upon religious ideas. When fanaticism is the cause of all 
these disorders, religious lypemania bursts forth with all its strangeness and 
excesses. It is what was witnessed among the gymnosophists, and what we 
at present observe among the brahmins, and faquirs ; among the methodists 
in England, and the martinists in Germany. 

I have seen many students who, animated by the desire of equaling or ex- 
celling their companions, after long continued study, became deranged. They 
were almost all masturbators. 

I have had charge of certain officers and clerks, who became insane in con- 
sequence of exhausting vigils, or the monotonous labors of the office ; and I 
ought to add, of pleasures. The same may be said of scholars, musicians and 
artists, in behalf of whom my advice has been sought. Thus excesses, and 
errors of regimen, ought to appear prominent, in the list of causes of mental 
alienation. 

The prevailing sentiments of every age, exercise a powerful influence, over 
both the frequency and character of insanity. It would seem that certain minds, 
impressed with new conceptions, cannot divest themselves of them. The same 
effect, which reflection, too long continued, produces upon individuals, is pro- 
duced upon an entire population. Thus, historical monuments prove, that at 
the birth of Christianity, there was much religious melancholy. 

The chivalrous spirit which succeeded the crusades, multiplied erotic me- 
lancholy. Civil and religious discords, excited by Calvinism, caused a return 
of religious melancholy. Magic and sorcery have had their turn. Ideas of 
liberty and reform have turned many heads in France, and it is remarkable, 
that those forms of insanity which have appeared within the last thirty years, 



40 INSANITY. 

have been characterized by the political convulsions, that from time to time 
have visited our country. 

Finally, it is not discoveries, nor is it a new institution, which always pro- 
duces insanity. 

One lady witnesses a phantasmagoria, and persuades herself that she is sur- 
rounded by phantoms. Another, sees the pretended invisible woman, and hence 
believes, that by some similar means, her lowest whispers may be heard at a 
distance. 

A young man assists at certain experiments in physics, and thinks himself 
subjected to electrical action, which causes his sufferings. 

A lady hears the subject of magnetism spoken of, and attributes her sleep- 
lessness and unpleasant feelings, to magnetizers 

The frequency of insanity, is always in relation with conditions in life, 
which render man more dependent upon social vicissitudes. 

Hence, far from passing by the palaces of kings, mental alienation is more 
frequent there, than elsewhere. 

Aristotle asks, why distinguished legislators are all melancholies. Cour- 
tiers, men eminent in society, and the rich, are more subject to this malady 
than the poor. Military men, the sport of capricious fortune, merchants, and 
above all reckless speculators, and clerks whose existence depends upon the 
will of their principals, all run the same hazards. 

TABLE OF PROFESSIONS AND MODE OF LIFE. No. V. 
Record of the Salpetriere. Record of my Estahlishnent. 

Field laborers 43 Husbandmen ....... 3 

Domestics 51 Soldiers 33 

Seamstresses 85 Mariners 3 

Cooks 16 Merchants 50 

Tradesmen (with fixed residences) 21 Students 25 

Pedlers 16 Administrators and clerks . . 21 

Shoemakers 8 Engineers 2 

Varnishers 5 Lawyers, Notaries and business 

men 11 

Chemists, glass dealers ... 4 

Physicians 4 

Artists 8 



Total 245 Total 164 

Living in families 192 151 

Public women ,33 Misconduct 6 

Abuse of wine 26 3 

Masturbation 10 . 14 

Change of condition .... 3 3 

Misanthropy 3 

Education (improperly directed) 20 



o 



Total 264 Total 200 

In casting our eyes over this table, we see that a sedentary life, such as the 
wealthy lead in the bosom of their families, and the poor in their households 
and the exercise of their callings, is the most common condition of individuals 
who are aifected with insanity. Some travelers assure us, that idleness is the 
cause of the greater part of the insanity which exists in Turkey. Sudden 



INSANITY. 41 

change of state, and the transition from an active life, to one of repose, lead 
to insanity. This happens to merchants who, after having acquired an hono- 
rable fortune, retire from business. We observe the same fact, among the 
French soldiery, who, after a wandering, vagabond life, passed amidst the 
greatest privations on the one hand, and abundance on the other, obtain per- 
mission to retire. After the year 1815, I noticed the same circumstance also, 
in the case of several officers. 

The desire for change of place, the mania for traveling, the uneasiness 
which some people experience, when they are without occupation, the break- 
ing up of habits, leaving the heart and mind a void, in the midst of which, 
man is tossed without the power of being satisfied, predispose to mental alien- 
ation ; whilst on the other hand, the abandonment of long formed habits, and 
the necessity for forming new ones, cause insanity, and often announce its im- 
mediate approach. Occupations, which expose man to the heat of the sun, 
and to the fumes of charcoal, favor the development of insanity. 

Those who are obliged to work in the midst of metallic oxyds, cooks and 
miners, are liable to the same attacks. 

The vapor of lead, produces in Scotland a species of insanity, in which the 
maniacs lacerate themselves at every opportunity, and which the Scotch pea- 
sants call, mill-reeck. 

The miners of Peru and Mexico, are subject to a peculiar form of insanity. 

It is pretended that dyers, who employ indigo, are sad and morose. 

The habit of drunkenness, of indiscriminate gallantry, of disorderly con- 
duct, or an apathetic indifference, are capable, says Pinel, of degrading the 
reason, and of bringing about, well marked mental alienation. 

Masturbation, that scourge of human kind, is more frequently than is sup- 
posed, the cause of insanity, especially among the rich. 

It would seem that this vice is more fatal to men than women. It is believ- 
ed to be most rare among the latter. This is an error which is to be attri- 
buted to the fact, that women are more reserved with reference to it than men. 
If continence, in some very rare cases, has caused mental alienation, liberti- 
nism is a more frequent cause of it, especially among common women. 

One twentieth of the alienated, admitted at the Salpetriere have been pros- 
titutes.* 

These miserable beings, cut off from society, are in a state of utter aban- 
donment. They know not upon what to support their wretchedness. After 
giving themselves up to every kind of excess, they generally sink into the most 
profound misery, and as a consequence, into dementia of a paralytic form. 

We shall see besides, that the abuse of alcoholic liquors, and the amorous 
excesses of some individuals, are not always the cause, but sometimes the 
first symptoms of insanity. 

The abuse of wine, liquors, and aromatic infusions of opium, produce a 
great amount of insanity. This cause ought to be regarded as producing half 
the cases of insanity that occur in England. In Peimsyivania, according to 
Rush, it is a very frequent cause. In France it is not rare, as any one may 
convince himself by observing the insane of the Bicetre, and of Charenton. 

In my own establishment, among three hundred and thirty patients, I have 
seen but three, who had given themselves up to the excessive use of wine, and 
liquors ; and I believe that one of them used it to excess, only after becoming 
insane. 

The abuse of wine and brandy, conduct either to suicide or dementia. Is 
not this the cause of so many suicides in England ? 

The consideration of professions, and modes of life, leads us to the study of 

* Vide Parent-Duchatelet : Concerning Prostitution in the city of Paris, etc., Paris, 
1836, t. I. p. 262. 

6 



42 INSANITY. 

morals, relative to mental alienation ; which, of all maladies, is that whose de- 
pendence upon public and private morals, is most manifest. 

Humboldt states, that he saw little insanity among the savages of America. 

M. Carr in his Ete du Nord, states that it is rarely met with in Russia, ex- 
cept in the large cities. In France, there is less insanity in the country, than 
in cities. 

The countrymen are more apt to contract religious, or erotic insanity. 
Among them, insanity is caused by the simple passions, love, anger, and do- 
mestic chagrin ; whilst in cities, it is produced by wounded self-love, disap- 
pointed ambition, reverses of fortune, etc. 

The less depraved morals of the Anglo-Americans, are one of the causes, 
in consequence of which there is less insanity among them than elsewhere ; 
as the reports of travelers prove, not less than the records of their own hos- 
pitals. 

In England, where we find united all the caprices, as well as the excesses 
of civilization, insanity is more Irequent than any where else. Unsuitable 
marriages ; those contracted by parents, and above all, alliances formed with 
families where there is an hereditary predisposition to insanity, the hazards of 
remote speculations, the indolence of the rich, and the habitual use of alco- 
holic drinks, are the causes which multiply insanity in England. " Every 
thing degenerates in the hands of man," said J. J. Rousseau. Without doubt, 
civilization occasions diseases, and augments the number of the sick, because, 
by multiplying the means of enjoyment, it causes some to live too well, and 
too fast. But the more perfect civilization becomes, and the more the life of 
the common people is ameliorated, the greater will be its medium duration. 
Moreover, it is not civilization that we are to accuse, but the errors and e.x- 
cesses of all sorts, which it enables us to commit. 

The morals of the Italians, render religious melancholy and erotomania, 
very frequent in Italy. 

The ignorance of the middle ages, caused demonomania and vampirism to 
multiply, and they are now reunited in the extreme north of Europe, as well 
as in other countries which civilization has not illuminated with its light, nor 
enriched by its benefits. 

For thirty years, the changes that have been going on in our morals in 
France, have produced more insanity than our political troubles. We have 
exchanged our ancient usages and opinions, for speculative ideas, and dange- 
rous innovations. 

Religion comes in only as a usage in the most solemn acts of life, — it no 
longer brings consolation and hope to the unfortunate. Religious morality no 
lonorer guides the reason, in the straight and difficult paths of life : — A cold 
egotism has dried up all the sources of sentiment. There is no more domes- 
tic affection, nor respect, nor love, nor authority, nor reciprocal dependencies. 
Each lives for himself; no one forming those wise combinations, which con- 
nect the present, with coming generations. 

The ties of marriage are mere pretences, which are formed by the wealthy, 
either as a speculation, or to gratify their self-love ; and which the common 
people neglect, through disdain for the clergy, indifference and libertinism. 
These deplorable facts, have prevented me from taking an account of the mar- 
riage state, of celibacy, or widowhood, among women who enter our hospital, 
and consequently, from being able to appreciate, among them, the influence of 
marriage in the production of mental alienation. 

About one fourth of the persons admitted into my establishment were ba- 
chelors y twenty-six only, were widowers. Having been concerned in the 
treatment of many soldiers, as well as students, this proportion of single men, 
of the higher class, will not be surprising. 



INSANITY. 43 

The change in our morals, will be felt longer, in proportion as our educa- 
tion is more defective. 

We take great care to form the mind, but seem to forget that the heart, like 
the mind, has need of education. 

The ridiculous and deplorable tenderness of parents, subjects to the caprices 
of infancy, the reason of mature age. 

Each gives to his son an education superior to that which is suited to his 
social position and fortune ; so that children, despising the knowledge of their 
parents, disdain the reproofs of their experience. 

Accustomed to follow all his inclinations, and not being habituated by dis- 
cipline, to contradiction, the child, having arrived at maturity, cannot resist 
the vicissitudes and reverses, by which life is agitated. On the least adversity, 
insanity bursts forth ; his feeble reason being deprived of its support, while the 
passions cire without rein, or any kind of restraint. 

When we add to these causes, the manner of life of the women in France, 
the insatiable relish which they have, for romances and the toilette, for frivo- 
lities, etc., together with the misery and privations of the lower classes, we 
shall no longer be astonished at the disorder of public and private morals, nor 
any longer have a right to complain, if nervous disorders, and particularly in- 
sanity, multiply in France ; so true is it, that whatever relates to the moral 
well-being of man, has always a most intimate connection with his physical 
well-being and the preservation of his health. 

We believe also with Pinel, that an undue severity, — that reproaches for the 
slightest faults, that harshness exercised with passion, that threats and blows, 
exasperate children, irritate youth, destroy the influence of parents, produce 
perverse inclinations, and even insanity ; especially, if this severity is the re- 
sult of the caprices and immorality of fathers. 

This system of severity, is less to be feared at this day, than that of which 
we have spoken above, particularly among those in easy circumstances, and 
the wealthy. 

The depravations of both minds and morals, which are effected by the vices 
of our education, by disdain for religious beliefs, and by the faultiness of pub- 
lic morals, exercises its influence, upon all classes of society. 

But how happens it, that we never cease to declaim against the higher class, 
and to extol the virtues of the people ? 

These philosophical decl aimers, lived with the great whom they calumniat- 
ed, and knew not the people. If they had studied the morals of their coun- 
try, they would have been convinced, that the corruption is most general, 
greatest, most hideous, among the lower class ; that it gives birth to almost all 
the evils of society ; that it produces much insanity, and at the same time 
much more of crime than in the higher classes. 

The vices of education in the higher classes, and the want of it in the low- 
er, explain these differences. Education, supplies the place of morals among 
the former ; while no motive suspends the arm of the mob. 

If the form of government influences the passions and morals of nations, 
we must not be surprised, that it exercises some influence, on the production 
and character of insanity. 

Scott, the companion of Lord Macarthney, saw but very few insane persons 
in China. 

All travelers assure us, that there are less than elsewhere, in Turkey, Spain 
and Mexico. 

It is, say the English, because those countries groan under a des]x>tism, 
which stifles the intellect, and represses the passions. 

On the other hand, a republican or representative government, in giving 
more play to all the passions, ought, other things being equal, to be more fa- 
vorable to the production of insanity. 



44 INSANITY. 

The laws which confiscated the property of the condemned, under the Ro- 
man Emperors, multiplied suicides. It was the same in France, during the 
reign of terror. 

A notary of Paris, enquires of one of his friends, if the father of a family, 
by taking his own life, would preserve his fortune for his wife and children. 
On receiving an affirmative reply, he drowned himself 

A military government which inspires contempt for life, multiplies suicides, 
because the people attach a greater value to some other good ; being ready, 
every day, to sacrifice themselves to their ambition. 

The law of conscription increased insanity in France, and at each period of 
departure, we observed an increase of insanity, either because the conscripts 
themselves became insane, or their parents or friends. 

Political commotions, by arousing to greater activity all the intellectual 
faculties, by rendering more intense, the depressing and vindictive passions, 
fomenting the spirit of ambition and revenge, overturning public and private 
fortunes, and changing the circumstances of all men, produce a vast amount 
of insanity. 

This is what took place in Peru after its conquest by the Europeans ; also 
in England, more than a century since. The same occurred in America after 
the war of independence, and in France during our revolutions, with this dif- 
ference between us and the English, that in England, according to Mead, it 
was those, who had recently acquired fortunes, that became insane, whilst in 
France almost all who had escaped the sythe of the revolution were seized 
with mental alienation. 

The influence of our political misfortunes has been so great, that I could 
give the history of our revolution from the taking of the Bastile to the last 
appearance of Bonaparte, from that of certain insane persons, whose insanity 
connects itself with the events which have signalized this long period of our 
history.* 

Here the question, so often propounded for forty years, presents itself; Is 
there now more insanity than existed previous to the revolution ? I am going 
to hazard my opinion with respect to it. 

Political commotions, like prevailing ideas, are not the predisposing, but the 
exciting causes of insanity. They call into action this or that cause, and im- 
press this or that character upon the insanity ; but this influence although 
general, is momentary. 

At the destruction of the ancient monarchy, many individuals became in- 
sane, through fear, and the loss of fortune. 

When the pope visited France, the religious forms of insanity were more 
numerous. When Bonaparte made kings, there were many Q,ueens and Kings 
in Houses for the Insane. 

At the epoch of the invasions of France, terror produced much insanity, 
particularly in the country. The Germans had made the same observations, 
at the time of our irruptions into their country. The individual, who now 
becomes insane by the loss of his fortune and rank, would have become so 
fifty years before, in consequence of the loss of his fortune at sea, or after a 
disgrace at court : that, whom the terrors of the revolution rendered insane, 
would have become so, two centuries ago, through fear of sorcerers and the 
devil. 

But why do we see so many, insane at the present day ? Why has their 
number doubled at Paris within thirty years 1 Why in 1786, were there at 
Parte, but one thousand and nine insane persons, whilst in 1813, there were 

* I could conthiiie this comparative history even to our own time. A magistrate be- 
lieved himself accused of the wicked attempt of Fieschi, and two young men believed 
themselves the accomplices of Alibaud. 



INSANITY. 45 

two thousand ; and about four thousand in 1836 ? We must conclude from 
this progressive augmentation of the insane at Paris, that their number must 
have doubled elsewhere. It has doubled and indeed tripled at Paris, because, 
since the impulse given by Pinel, they have multiplied the means of relief at 
the capital ; the asylums open to the insane are increased in size, and improv- 
ed in their condition ; the physicians devote themselves to this service more 
especially ; better care is taken of the sick, and a greater number are cured. 
We speak of them with more interest and hope ; they are more in evidence ; 
and their life is prolonged. From a record kept for ten years at the Salpetri- 
ere, it is shown that one third of the women, admitted into the class of the 
insane of this hospital, are very aged, paralytic, and in senile dementia. The 
same is true at Charenton and at the Bicetre. These intirm patients would 
have remained formerly, in their families ; but the hope of a cure, causes 
them to be brought, at this day, into establishments where they are submitted 
to remedial treatment. 

People avail themselves of an easy means of relieving themselves from the 
burthen of their support. 

This fact, furnishes the reason for the frightful increase of the inmates of 
the hospitals of France ; where they receive as insane, all those individuals 
who are presented, with no other condition, than that they are in a state of 
delirium. 

In those cities where they have augmented the size, and improved that por- 
tion of their hospitals devoted to the insane, as at Limoges, Orleans, Tou- 
louse, etc., in cities where they have erected establishments, especially design- 
ed for this class, as at Bordeaux, Rouen, Caen, Nantes, Lyons, Mans, etc., the 
number of the insane has wonderfully increased. 

It is remarkable, that this increase has no where taken place, except where 
the erection of buildings, and improvements in their treatment have begun. 

Formerly, the insane were admitted into certain convents and religious 
houses, where they were subjected to the supervision of the police.* 

From all these considerations, we may conclude, that if the number of the 
insane has increased since the revolution, this augmentation is more apparent 
than real ; that it is far less considerable than we are accustomed to suppose ; 
that this increase is less due to the storms of the revolution, which were tran- 
sient, than to the profound change which it has effected in our morals, whose 
influence is more durable. Let us not seek, by exaggerating them, to thicken 
the evils which, for so many years have weighed down our unhappy country. 

7. Passions. — During the last century, we gave great importance to the 
study of the intellectual and moral man. Cabanis, embellished his researches 
with the most seductive diction, and reduced almost to a demonstration, the 
reciprocal influence of the moral upon the physical. 

Crichton has made a more direct application of the study of the passions, 
to the causes of mental alienation. Pinel, in the second edition of the Trea- 
tise on Gladness, has adopted the division of the passions proposed by Moreau 
de la Sarthe. This division, is based upon pathological views. 

Thus Moreau and Pinel regard the passions as spasmodic agents, debilitat- 
ing or exciting, which produce insanity. 

Is this division, which ought to be especially agreeable to physicians, of 
general application in the study of mental alienation ? 

In my Dissertation on the passions, considered as causes, symptoms and cu- 
rative means of mental alienation, I have principally considered them^ ant the 
most essential symptoms, and the most powerful therapeutic agents in insanity 

The first wants of man, limiting themselves to those connected with his 

* I discussed this question in a memoir, entitled, ^^ Are there more insane persons now 
than formerly" ? 



46 INSANITY. 

preservation and reproduction, provoke the determinations of instinct ; an in- 
ternal impulse leads us to gratify them. 

The secondary wants, attach themselves to the first, and the desires which 
they excite, acquire as much more energy, as we have means of satisfying 
them. They produce the primitive passions ; in fine, they are the wants 
which are connected with our preservation ; and are the fruit of our increas- 
ed intelligence and civilization. They engender the factitious passions, — 
those passitms which cause the greatest injury to man, especially in the higher 
walks of life. 

Infancy, exempt from the influence of the passions, is almost a stranger to 
insanity ; but at the epoch of puberty, the sentiments, unknown until this pe- 
riod, cause new wants to arise. Insanity then appears, to trouble the first mo- 
ments of the moral existence of man. 

At mature age, the relations become extended, social wants multiply, and 
the passions take a new character. In proportion as the amorous passions be- 
come enfeebled, those of a factitious nature grow strong. Personal interest, 
ambition, love of distinction, and avarice, replace the charms of love and de- 
lights of paternity. 

At this period of life also, mental alienation appears ; insanity is more ob- 
stinate, and more concentrated. It passes more readily into a chronic state ; 
and is more dependent upon abdominal lesions. 

A sense of his weakness, renders the old man more calm ; and while medi- 
tating upon the errors to which the passions lead, he isolates himself, and be- 
comes an egotist. 

Insanity from a moral cause, rarely exists with him, and when he loses his 
reason, it is because his organs are fatigued and exhausted. Hence, it is nei- 
ther mania nor monomania which is developed, at this period, but senile de- 
mentia. 

Of all moral causes, those which most frequently produce insanity, are 
pride, fear, fright, ambition, reverses of fortune, and domestic trouble. This 
last should have been placed, relative to its great influence, at the head of 
moral causes, if it be limited to a simple idea ; but by domestic troubles, I 
express all the pains, all the griefs, all oppositions, misfortunes and dissen- 
sions, that grow out of the family state. 

One can scarcely imagine how strongly this cause operates upon the minds 
of the people, especially females. Forgetful of all principle, habits of immo- 
rality the most vile, and often the most criminal, render prostitutes the victims 
of the most ferocious brutality. 

The gay and enlivening emotions, are rarely the cause of this malady. It 
is singular, that the excess of joy which destroys life, never takes away the 
reason, while anxiety and chagrin so often cause its loss. Some authors how- 
ever, are of the opinion, that this class of emotions have caused insanity. 

Mead assures us, that fortunes rapidly acquired, produce insanity in Eng- 
land. 

But are they not seized with this disorder, in consequence of laying aside 
their former habits, of living in idleness, of committing every variety of error 
in regimen, and because their newly acquired wealth, being the fruit of spoli- 
ations and intrigues, fills them with disquietude, not being in the habit of en- 
joying it. 

In examining with care, the causes of certain cases of insanity which have 
been attributed to joy, I have assured myself that it was a mistake. 

A minister informs his relative of his nomination to an important place. 
The latter, stricken as with a blow at the epigastrium, falls suddenly into hypo- 
chondriacal lypemania. Joy had no effect in bringing about this malady, as 
was universally supposed, but rather despair at quitting a mistress. 

A young man gains a prize in a lottery ; some days after he is seized with 



INSANITY. 47 

insanity ; it is reported that excessive joy has produced this affectino- result. 
It is not joy, however, but the fear of being robbed, and losinor his treasure 

One of the moral causes pointed out by Pinel, and which is frequently met 
with in practice, is the conflict which arises between the principles of religion, 
morality, education and the passions. 

This internal wrestling, continues for an indefinite period of time, and ends 
by producing insanity, and even characterizing certain forms of lypemania. 

Religious fanaticism which caused so much insanity formerly, has now 
lost all its influence, and very rarely produces this disorder. 

Among more than six hundred insane persons, eight only became so in con- 
sequence of religious terrors. 

I have never known insanity to be produced by ascetic exaggeration but 
in a single instance, among 3:37 individuals admitted into my establishment. 
Love, which so often causes erotomania, and even nymphomania in warm 
countries, has lost its empire in France. Indifference has taken possession of 
the mind, and the amorous passions, have neither the exaltation nor the purity, 
which would engender erotic insanity. 

Moral causes act sometimes individually : at others, several combine to 
overthrow the same individual. A young man is stricken with mania. The 
conscription has just taken from him both his place and liberty. 

A young man pays his addresses to a lady whose parents refuse to permit 
their union. He is sorrowful and dejected. Some months after, on beino- 
informed that she whom he adores, is married, he betakes himself to the 
place where the nuptials are celebrated, and there blows out his brains. 

A young lady is married in obedience to the wishes of her parents. She ap- 
peared happy, though often sad. A year after, her husband is ruined. She 
supports this new trial, but loses her reason, on learning that he is unfaithful 
also. 

Moral causes unite ordinarily with physical, particularly among women. 

A young person during the catamenial effcirt, is frightened by a sudden clap 
of thunder, and her menses are suppressed. She becomes insane, and reason 
is established only after the restoration of this accustomed discharge. 

A young woman is confined happily. On the seventh day, her father re- 
proaches her violently, and unexpectedly. Both the lochia and milk are sup- 
pressed. The lady becomes a maniac, and falls into a state of dementia after 
a month of intense excitement, and is cured at the end of six months. 

This combination of physical and moral causes, is much more frequent in 
the production of insanity, than the isolated action of either of them. 

TABLE OF MORAL CAUSES. No. VI. 
Salpetrierc during the years 1811 and 1813. My Establishment. 

- :il 

- 31 
1 
8 

14 



7 Reverses of fortune 14 

- 16 
12 

- 13 
- - 2 

Total - - 167 



Domestic troubles 


- 105 


Disappointed aifection 


46 


Political events 


- 14 


Fanaticism - - _ 


8 


Fright ... 


- 38 


Jealousy - . . 


18 


Anger - . - 


- 16 


Misery, and reverses of fortune 


i 1 


Wounded self-love 


1 


Disappointed ambition 





Excessive study 





Misanthropy 





Total 


- 323 



48 INSANITY. 

Moral causes are much more frequent than physical A comparison of the 
record of moral causes, kept at my establishment and at the Salpetriere, 
proves this, and the reports which I have since made at the same hospital, and 
at Charenton, confirm it. 

The Memoir, read by Pinel at the Institute, in 1807, also demonstrates the 
same fact. 

A report, made in Pennsylvania in 1812, gives the same result, since among 
fifty insane persons from whom their account was made up, thirty-four had 
become so, as a result of moral affections, and sixteen from physical causes. 

Experience has demonstrated the same thing to Mr. Tuke, founder and di- 
rector of the Retreat near York ; and in fine, the same has been every where 
observed, because man is every where the same. 

In comparing the two reports, relative to fortune and rank in society, we 
may conclude, that moral causes are more numerous among the rich, since 
the first column embraces six hundred insane poor, and the second three hun- 
dred and thirty-seven. 

Physical causes act more frequently upon women than men ; and we shall 
readily perceive that this must be so, if we call to mind the numerous acci- 
dents to which women are liable, during the period of menstruation, pregna- 
cy and lactation. These causes produce a powerful influence upon the lower 
classes. The form of insanity which they produce, is ordinarily dementia. 

In like manner, there exist certain atmospheric conditions, which, at some 
seasons, render maladies epidemic or contagious. In minds also, there exist 
certain general dispositions, which cause mental alienation to extend, and 
communicate itself to a great many individuals, by a sort of moral contagion. 

It is what we have observed at all times, and in all countries. The example 
of the daughter of Proetus was contagious. The women of Lyons fell into 
suicidal lypemania, in imitation one of another. 

Demoniacal possessions, which have afflicted different countries of Europe, 
even to the commencement of the last century, establish in a satisfactory man- 
ner, the existence of this influence, which besides, allies itself to all the phe- 
nomena of sensibility. Examples will multiply, when I speak of monomania 
and suicide. 

The causes of which we have spoken heretofore, and which we may call 
general, differ from the following, in this respect, that the latter are more in- 
dividual. They act more immediately upon the organism. Their action is 
more appreciable, and can, to a certain extent be prevented. The means pro- 
per to combat their results, ought to be added to the list of pharmaceutic 
agents. 

Such are the causes, which we have called more particularly physical, while 
the preceding have been hygienic, intellectual or moral. 



11 




- 


4 


- 11 


- 


. 


2 


55 




- 


19 


- 52 


- 


. 


21 


27 




- 


11 


- 60 


. 


. 


4 


12 




- 


4 


- 14 


- 


. 


4 


13 




- 


12 


8 


- 


- 


1 


14 




- 


18 


- 24 


- 


. 


4 


60 




- 


10 


- 466 


Total - 


264 



INSANITY. 49 

PHYSICAL CAUSES. No. VII. 

Salpetrierc. My KstabUshmcnt. 

Hereditary - - - 105 - - - 150 

Convulsions of the mother during 

testation ... 
Epilepsy 

Menstrual disorder 
Results of confinement 
Critical period 
Progress of age 

Insolation ... 
Blows or falls upon the head 
Fevers ... 

Syphilis 

Mercury - - . 

Intestinal worms 
Apoplexy ... 

Total 

Hereditary predisposition is the most common, among the remote causes of 
insanity, particularly among the rich ; and is in the proportion of one sixteenth 
among the poor. I believe, nevertheless, that the proportion is greater, even 
amoncr the latter. 

If, from my records of the Salpetriere, this cause appears feeble, it is in 
consequence of the difficulty which attends the making up' of correct returns, 
among women who are often ignorant, even of the name of their parents. 
Mason Cox attributes great influence to this predisposition. Little however, 
is accorded to it in Pennsylvania, by Rush. 

It is rxsmarkable in England, especially among the Catholics, who always 
ally themselves in marriage, with those of their own denomination. The 
same may be said of the great lords of France, who are almost all parents. 
What a lesson for fathers, who in the marriage of their children, consult ra- 
ther their ambition, than the health of their descendants. 

Insanity is rather transmissible by mothers, than fathers.* 

Children who are born before their parents have become insane, are less 
liable to mental alienation, than those whose births take place afterwards. 

The same is true of those who are born of parents, who are insane only 
upon the paternal or maternal side, compared with those, both of whose pa- 
rents are insane, or who have progenitors on both sides in this condition. 

Burton assures us, that those begotten of aged parents, are predisposed to 
melancholy. 

This fatal inheritance is pictured upon the physiognomy, and external 
forms ; as well as the ideas, passions, habits and inclinations of those who are 
destined to become the victims to it. Attracted by some one of these signs, 
I have sometimes foretold an attack of insanity, many years before it made its 
appearance. 

Hereditary mania manifests itself among parents and children, often at the 
same period of life. It is provoked by the same causes, and assumes the same 
character. 

A Swiss merchant saw his two sons die insane, at the age of nineteen years. 

* I have in charge at the present time, many children whose parents were under my 
care, during the first years of my medical practice. 

7 



50 INSANITY. 

A lady became insane at twenty-five years of age, after confinement. Her 
daucrhter becomes so, at the same age, and from the same cause. In the 
same family, both father, son and grandson, commit suicide at about the fif- 
tieth year of their ages respectively. 

We have had at the Salpetriere a prostitute, who has thrice thrown herself 
into the river after her frantic revels. Her sister drowned herself in a state 
of intoxication. There lives in the environs of Nantes, a family of whom 
seven brothers and sisters are in a state of dementia. A gentleman, shocked 
at the earlier events of the revolution, remains during ten years, shut up in 
his apartment. His daughter at about the same age, falls into a similar state, 
and refuses to leave her apartment. 

This predisposition, which manifests itself by the external conformation, by 
the moral and intellectual character of individuals, is not more surprising with 
reference to insanity, than to gout, phthisis pulmonalis, etc. It is noticeable, 
even from infancy. It will explain a multitude of whims, irregularities, and 
anomalies of character, which should betimes, have put the parents on their 
guard. 

It may prove a useful hint, to those who preside over the education of chil- 
dren born of insane parents. It will be proper to give to these children a pe- 
culiar education, to exercise them much in gymnastics, to inure them to ex- 
ternal impressions ; in fine, to place them in a condition different from that of 
the authors of their being, according to the precept of Hippocrates ; who re- 
commends that the constitution of the individual should be changed, to pre- 
vent those maladies, to which, by hereditary descent, it is liable. 

What has been said with respect to physical education, I would also say 
with respect to the moral and intellectual. We must be on our guard, against 
whatever may unduly excite the brain. 

Sometimes it is to the maternal womb, that we are to look for the first cause 
of insanity ; not only idiocy, but the other forms of mental alienation. I 
know not why this circumstance has escaped the notice of observers. 

At others, it is during the period of nursing, or the first dentition, that the 
elements of the malady take root in the system, which is at a later period to 
appear. According to Van Swieten, almost all the insane have had convul- 
sions during their infancy. I have, however, observed several insane young 
persons, who, during their infancy, and at puberty, had escaped cerebral 
fevers. 

Sometimes, strong impressions, received in early life, are also the remote 
cause of insanity. Many women, who were pregnant at various periods of 
the revolution, have become the mothers of children, whom the slightest cause 
has rendered insane. A female of the lower orders is pregnant ; and her hus- 
band, under the influence of wine, threatens to beat her. She is frightened, 
and sometime after is confined, with a child of exceedingly delicate health, 
who is subject to panic terrors, and who, at the age of about eighteen years, 
becomes insane. A lady, while pregnant, exposes her life a thousand times, 
to save that of her husband. She has convulsions, and is confined. Her 
daughter, born feeble, and subject to terrors, is married, and becomes the 
mother of four children. At twenty-three years of age, frightful thoughts of 
assassination and murder, alone occupy her mind, and render her furious. 

A young child, three years of age, who was brought to the Bicetre, is 
frightened at the bears exhibited there, as a curiosity. From that time, he 
was subject to frightful dreams, and at seventeen years of age, was seized 
with mania. 

A girl, six years of age, sees her father massacred, and has since been sub- 
ject to panic terrors. At fourteen, her menses were imperfectly established, 
and she becomes a maniac. She wishes to rush upon every body. The sight 



INSANITY. 51 

of a knife or weapon, or of many men assembled, excites her to the most vio- 
lent fury. 

Falls upon the head, even in earliest infancy, predispose to insanity, and 
are sometimes the exciting cause of it. These falls, or blows upon the head, 
precede by many years, the explosion of delirium. 

A child of three years of age, fiills upon his head. He complains from that 
time of headache. At puberty, the pain in the head increases, and mania 
manifests itself at the age of seventeen years. A lady, returning from a ride 
on horseback, strikes against a gate, and is thrown from her horse. Some 
months after, she becomes insane, is cured in about three months, and dies 
two years afterwards in consequence of a cerebral fever. 

Rush relates several analogous cases. 

Masturbation, of which we have spoken under another head, is signalized 
in all countries, as one of the frequent causes of insanity. 

Sometimes it is the prelude of mania, of dementia, and even of senile de- 
mentia. Its effects are more deplorable upon men, than women. 

It is a great obstacle to the cure of those, who give themselves up to the 
frequent practice of this vice, during the course of their disease. 

Cretins, idiots, and individuals in a state of dementia, abandon themselves 
to it, with a sort of fury. Continence, although rarely, sometimes causes 
insanity. 

Buffon has borrowed at Espion (turc) a very remarkable fact, since exten- 
sively copied, viz., that mania has been caused by continence. 

Is widowhood, which we have elsewhere considered under the head of mo- 
rals, a cause of mental alienation ? It is not easy to ascertain the effect of 
this influence upon the women at the Salpetriere, as their mode of life, both 
before and after marriage, renders continence impossible. 

Among the wealthy belonging to this class, whose morals are generally cor- 
rect, I have found, among one hundred and forty-four individuals, admitted 
into my establishment, forty-four single women, eighty who were married, and 
twenty widows. 

The proportion of single persons is much greater among the men, since of 
one hundred and ninety-two, sixty-one were not married, and eight only 
were widowers. 

I have seen some young women who, having been violated, have lost their 
reason. Shame and mortification were the cause of their malady. 

I have had charge of a lady who was seized with an attack of mania on 
the first night of her marriage. Her modesty was shocked, at being obliged 
to lodge with a man. 

An extremely nervous young woman, was so painfully affected by the first 
approaches of her husband, that her reason forsook her immediately. 

Menstruation, which performs so important a part in the economy of wo- 
man, cannot be a stranger to the production of mental alienation. It even 
occupies the sixth place among physical causes. 

The first menstrual effort, sometimes produces insanity. This observation 
did not escape Hippocrates. 

Disorders of menstruation, provoked by physical or moral accidents, or by 
the progress of age, multiply the conditions, favorable to mental alienation. 

Now, the menses are suppressed suddenly, and insanity speedily ensues. 
Now, they present remarkable anomalies, either as it respects the period of 
their return, or the quantity and quality of the discharge, before insanity de- 
clares itself 

Sometimes the menses are very abundant, and appear at brief intervals, for 
a short time before the invasion of insanity. 

In fine, there are cases, where insanity manifests itself, without the least 
menstrual disorder. 



52 INSANITY. 

The period of the menstrual returns, is always one of excitement among in- 
sane women, even with those whose menses are not deranged. 

LeucorrhcEa, which is often supplementary to the menses, to which pros- 
titutes, and women who lead a sedentary life are so subject ; when suppressed, 
also causes insanity. I add that this cause is more frequent than is generally 
supposed, and that the knowledge of this fact, may become a very valuable 
therapeutic indication. 

The suppression of hemorrhoidal discharges, is almost as fatal to men, as 
that of the menses is, to women ; but its influence, being exerted at a more 
advanced age, most frequently produces melancholy and dementia. 

Is pregnancy the cause of insanity, and is it complicated with this disease 
in any case ? I speak not of the longings of pregnant women, nor of the 
moral perversions observed among them. 

Writers on legal medicine, report several cases of it. I have seen a very 
nervous young woman, who had an attack of mania, on the first night of her 
marriage, and a second on the first day of conception. The same was true at 
her second pregnancy. These attacks lasted but about fifteen days. We have 
seen at the Salpetriere, many women become insane during pregnancy. If 
this ought to be ranked among physical causes in some cases, there are others 
where it is set in action by moral ones. 

Shame, chagrin, and fear, are then the true causes of the malady. 

A lady, on the second day of her confinement, leaves her bed, and sprinkles 
a large quantity of Cologne water over her garments, and about her apart- 
ments. The next day she is a maniac. A lady experiences a moral affection 
on the seventh day of her confinement. The lochia are suppressed as well as 
the milk ; and she becomes furious. 

But insanity takes place more frequently after confinement and during lac- 
tation, than during pregnancy. According to a report made at the Salpetri- 
ere, of six hundred insane women, 52 had lost their reason after confinement 
or lactation. Of 144 insane women belonging to the wealthy class, 21 were 
taken sick, as the result of their confinement, or whilst they were nursing. 
This last influence, is therefore more active still, among the latter, than wo- 
men of the lower classes. 

Haslam enumerates 84 women who became insane as the result of confine- 
ment, out of 1664 admitted at Bethlem. Rush found 5, out of 70 received 
at Pennsylvania. At Charenton, those who became insane in consequence of 
confinement, are very rare. 

We have had, at the Salpetriere, women who became deranged after each 
confinement, and one among them, after every second confinement. 

A lady who had an hereditary predisposition, became insane at the third 
month of lactation. 

Hippocrates said that the blood, which mounts to the breasts of nurses, pre- 
sages mania. 

Planchon cites a case of it. But is the suppression of milk a cause or 
effect of delirium ? It has been pretended, that it is always the result of the 
cerebral affection ; but this has not been demonstrated in every case. There 
are ca.ses in which insanity appears, while the milk is not suppressed ; but this 
suppression, most frequently precedes alienation. Sometimes delirium in- 
creases, in proportion as the milk diminishes ; while it ceases, on the re-estab- 
lishment of this secretion. These cases of alienation, of which we shall not 
attribute the cause to ecstasy, or to the accumulation of milk in the cranial 
cavity, are cured even in a few days, but more frequently after five and six 
months, or a year.* 



nurses. 



Vide hereafter : Concerning the mental alienation of the newly confined, and of 



INSANITY. 53 

The first dentition, by causing convulsions in children, predisposes to insa- 
nity ; while the tardy appearance of the teeth, has sometimes provoked this 
malady. 

The suppression of the transpiration, which is determined by the moral af- 
fections, ought to stand conspicuous among the causes of mental alienation. 
It is by its suppression, that atmospheric vicissitudes, the humidity of the soil, 
errors of regimen, excessive study, and the passions, produce insanity. 

A man about forty-six years of age, was accustomed to perspire copiously 
from his head. He was advised to bathe it with cold water. The perspira- 
tion was suppressed by degrees, and dementia established. 

A young man in a state of perspiration, crosses a streamlet. He retires 
with a chill, and immediately becomes a maniac. 

Fevers of a grave character, leave after them a chronic delirium which must 
not be confounded with mental alienation ; nor must we confound continued, 
or intermittent ataxic fevers, with insanity, at its first appearance ; a point of 
practice well worthy the attention of the physician, — inasnmch as, mental 
alienation at its invasion, often presents almost all the characters of ataxic fe- 
ver, or inflammation of the meninges of the brain, and reciprocally. 

These fevers, and inflammations of the meninges and encephalon, by en- 
feebling the cerebral system, predispose to insanity, which appears after some 
months, sometimes years. 

We often meet with young men of eighteen, twenty, and twenty-five years, 
who are suddenly seized with mania, without other appreciable cause, than an 
acute cerebral affection, which had taken place before, or at the period of pu- 
berty. 

The presence of various substances in the first passages has produced, by 
sympathy, mental alienation. 

Mucous, bilious, and depraved masses in the stomach, worms in the intesti- 
nal canal, tceniiE, lumbricoides and strongyli, have produced insanity. 

I speak not of the effect of poisons, although their mode of action upon the 
cerebral functions, merits the greatest attention on the part of one who would 
thoroughly understand the lesions of the intellectual faculties. Poisons pro- 
duce a consecutive effect, which, in altering the sensibility, causes a secondary 
insanity, whose cure is very diflicult. 

A great number of chronic affections, either in consequence of their incon- 
siderate suppression, or by their metastasis, produce insanity. 

Hippocrates said, that the checking of expectoration, in cases of phthisis, 
occasions wandering of the intellect. It is certain that phthisis causes, or at 
least precedes mental alienation, and alternates with it. 

Epilepsy, sooner or later, leads to insanity, either in infancy, or at a more 
advanced age. Of the three hundred epileptics who reside at the Salpetriere, 
more than one half are insane. The same is true of those at the Bicetre and 
at Charenton. Some are idiots or imbeciles, others in a state of dementia, 
and others still, maniacs, and even furious. 

The fury of epileptics, has a character of ferocity which nothing subdues ; 
and it is this circumstance that renders it so formidable in all hospitals for the 
insane. 

Hysteria and hypochondria degenerate, and often pass into insanity, and in 
many cases are only the first degree of it. This has caused these maladies to 
be confounded with mental alienation, by a great number of authors, as well 
ancient as modern. 

Apoplexy often terminates in dementia, which is complicated with paralysis. 
The suppression of a nasal discharge, of blennorrhao-ia, of an ulcer or issue, 
has produced insanity, as well as the retrocession of psora, tetter, gout or rheu- 
matism. The suppression of these affections, is not always the cause of in- 
sanity, but usually precedes its invasion. The abuse and even the use of 



54 INSANITY. 

medicines which act powerfully upon the nervous system, have caused insanity 
among those who were predisposed to it. It is not rare that persons become 
insane, during a mercurial treatment. We can say as much of the abuse of 
opium, and other narcotics. 

We have already seen, that those occupations which expose the person to 
the fumes of charcoal, predispose to insanity. We ought to add, that as- 
phyxia by carbon, is very liable to cause dementia, and that too in its incura- 
ble form. 



III. COURSE OF INSANITY. 

In this section, after having traced in a general manner, the course of insa- 
nity, I shall give some details respecting its terminations ; and close by con- 
siderations concerning the cure, and mortality of the insane. 

The causes of mental alienation, do not always act directly upon the brain, 
but upon organs more or less removed therefrom. 

Now, the extremities of the nervous system, and the foci of sensibility situ- 
ated in different regions ; now, the sanguine and lymphatic systems ; now, the 
digestive apparatus ; the liver and its dependencies, or the organs of reproduc- 
tion, are each, respectively, the point of departure, of the malady. 

Here airange themselves naturally, the considerations respecting the in- 
fluence of different organs, in their physiological, or pathological states, upon 
the sensations, ideas, understanding, and will ; as well as upon the passions 
and determinations of man ; so thoroughly understood by Cabanis, Cogan, 
Crichton, and Moreau de la Sarthe.* 

Predisposing causes sometimes act with so much energy, as to produce in- 
sanity, without any apparently exciting cause, and reciprocally ; so that the 
causes of mental alienation, cannot be rigorously classed, according to their 
degree of influence. 

Proximate or exciting causes, whether physical or moral, act promptly. 

Generally, their effect upon the system is slow, especially in the production 
of dementia, and even lypemania. 

I am convinced that these causes act promptly, only in cases strongly pre- 
disposed to insanity. Almost all the insane, presented before their sickness, 
certain functional changes, which extended back many years, even to earliest 
infancy. The greater part had suffered from acute encephalic inflammations, 
convulsions, pains in the head, colics, cramps, constipation and menstrual 
irregularities. 

Many were endowed with great activity of the intellectual faculties, and had 
been the sport of the most impetuous, and angry passions. Others still had 
been peculiar in their ideas, affections and actions. 

Some, led away by a disordered imagination, would have been incapable of 
a systematic course of study ; others, obstinate to excess, could live, only in a 
very limited circle of ideas and affections ; whilst many, without intellectual 
and moral energy, were timid, fearful, irresolute, and indifferent about every 
thing. With these dispositions, an accidental cause only is wanting, to pro- 
duce an attack of insanity. 

But insanity, like all other maladies, has its period of incubation, its pre- 
monitory indications, and often in the history given by friends, it is discover- 
ed that the first act of insanity which frightened them, had been preceded by 
many symptoms, which escaped all observation. Sometimes, the early phe- 
nomena of the disease, are regarded as the cause of the malady. 

The insane often combat their false ideas and unusual determinations, be- 

* Mental diseases ; Encyclopedia methodical. 



INSANITY. 55 

fore any one perceives the disorder of their reason, and the internal struggle 
which precedes the outbreak of insanity. 

A long time before an individual may be regarded as insane, his habits, 
tastes and passions, change. One surrenders himself to wild speculations, 
which do not succeed ; and the consequent reverses are not the cause, but the 
first effect of the malady. 

Another, all at once engages in the loftiest acts of devotion, and is present 
at the delivery of a sermon, from which he goes away stricken with fear, be- 
lieving himself damned. The sermon would not have produced this effect, if 
the malady had not previously existed. 

A young lord, without any motive, undertakes a voyage of many years' du- 
ration, eight days before the confinement of his wife. He experiences some 
opposition during the voyage, and after six months, his mental alienation be- 
comes manifest. Was not this voyage the first act of his insanity ? It often 
happens also, that the evil exists, at a time when it is not suspected. 

M. ***, about sixty-four years of age, of a dry and nervous temperament, 
who had led a very quiet, moral life, suddenly leaves his house, under the pre- 
text of taking a walk. 

His wife, suspecting something, ordered his valet to follow him. He sees 
his master enter a most disreputable place. Upon the slightest allusion to it, 
the old man has a furious paroxysm of anger, which, after five days, termi- 
nates in dementia. 

Insanity is continued, remittent or intermittent. 

Continued insanity has a regular course, a space of time that it is to run, 
and three distinctly marked periods. A first period acute, with concomitant 
sypmtoms ; a second, chronic, almost always exempt from symptoms foreign 
to the delirium. The third and last period, is that of the decline and cure. 

But this course is easy to recognize, only in acute or accidental cases of in- 
sanity ; or in attacks of intermittent insanity. It is never observed in idiocy, 
nor in dementia. 

Remittent insanity offers very remarkable anomalies, either as it respects its 
character, or the duration of the remission. 

This, in some cases, is but the passage from one form of delirium to another. 

Thus, an insane person passes three months in lypemania, the three follow- 
ing in a state of mania, and finally, four months, more or less, in dementia ; 
and thus successively ; now with great regularity, and now with striking va- 
riations. 

A lady, aged fifty-two years, is one year a lypemaniac, and one, maniacal 
and hysterical. In other circumstances, the remittence presents only a sensi- 
ble diminution of the symptoms of the same species of insanity. 

Thus, there are maniacs, who are agitated, violent and passionate, only at 
certain periods of the day, at certain hours, and at certain seasons ; whilst 
their delirium is calm and peaceful the rest of the time. 

There are those, whose lypemania becomes more profound and oppressive 
at irregular intervals ; while it usually offers all the characteristics of a fixed 
delirium, combined with the gay and jjleasurable emotions. The seasons, and 
also menstruation, produce a recurrence of the same symptoms, and delirium ; 
the same exaltation and oppression. 

Intermittent insanity is quotidian, tertian, quartan, monthly and aimual. 
In fact, attacks recur after an interval of many years. It is now regular ; now 
irregular. In the first case, the same season and period of the year ; the 
same physical and moral causes, bring back a malady, having the same cha- 
racter, crises and duration. More generally, the attacks return at very variable 
intervals. They are provoked by new causes, and do not present the same 
form of delirium. Their duration and crises are different ; and the attack 
breaks forth, sometimes suddenly, but is more frequently announced by various 



56 INSANITY. 

signs, which are ordinarily, the same with those which have preceded the first 
attack. 

Among the insane, some suffer from cephalalgia, insomnia or somnolence. 
They lose their appetite or eat voraciously. They suffer also, from constipa- 
tion, abdominal pains, intestinal heat, etc. Others have presentiments, dreams, 
and strange ideas. We see those, whose attack is always preceded by great 
loquacity, by an unusual inclination to the pleasures of love, by an irresistible 
desire to move about, and to whistle. There are others whose character and 
affections, tastes and habits, are changed. They become irritable, querulous, 
suspicious, and choleric ; or taciturn, gloomy and melancholic. Finally, after 
some months, weeks, days or moments, the attack bursts forth, runs its course, 
and terminates by crises more or less complete. Not unfrequently, the attack 
ceases abruptly, without any precursory indication of its approaching termina- 
tion. 

We have just seen, that insanity, in some sort transforms itself, and that the 
different forms of delirium, replace, and succeed each other. 

We ought to add, that by their complication, binary or ternary compounds 
are formed. 

Lypemania complicates itself with mania ; dementia, with mania and mono- 
mania. I have seen an imbecile yield to an attack of chagrin. In fine, we 
have seen the insane, who had fallen into a state of dementia, preserve the 
primitive character of their delirium, and have at intervals, attacks of mania 
and even fury. Many observations, detailed farther on, will demonstrate these 
combinations. 

Insanity is very often complicated with cerebral lesions, such as chronic in- 
flammation of the meninges, paralysis, convulsions, epilepsy, hypochondria 
and hysteria. It is complicated with affections of the lungs, of the heart and 
intestines, and of the skin ; either because these latter maladies have preceded 
insanity, and ceased at its incursion, or proceed simultaneously, or alternate 
with it. 

The insane are not secure against intercurrent maladies, and epidemics. 
The latter, often have an influence, more or less marked, upon insanity : either 
suspending its march, causing it to cease, or terminating the life of the insane. 

Why is not the doctrine of crises, applicable to mental alienation ? Has 
not insanity its causes, symptoms, and a course which is proper to it ? Why 
should it not terminate like other maladies ? The cure is certain, only when 
it has been marked, by some sensible crisis. When insanity ceases suddenly, 
without our being able to assign any critical cause, we ought to fear, lest we 
have to do with its intermittent form. If insanity pass so often into a chronic 
state, it is because the critical efforts are rarely perfect, and often abortive, 
for the following reasons ; 1, because the malady attacks enfeebled subjects; 
2, because its most common causes are debilitating ; 3, because the suscepti- 
bility of individuals, and the ataxia of the symptoms, interfere with the course 
of nature. Hippocrates, Celsus, Ccelius, Boerhaave and Pinel, have pointed 
out many crises of insanity, as well as all the physicians who have written re- 
specting it. These crises are physical or moral. They are observed only 
in monomania, lypemania, mania, and acute dementia. They do not occur in 
imbecility, or in chronic or senile dementia. 

Insanity terminates by resolution. Paleness of the face, which was of a 
lively red, or earthy brown ; the composure of the features ; a sense of gene- 
ral lassitude, sleep, suppleness of the skin, freeness of the excretions, and the 
return of moral sensibility, presage a cure as near at hand. This is perfect, 
if at the same time that the patient is restored to reason, the habitual evacua- 
tions are reestablished, and the convalescent returns to his former habits and 
character. 

But if sleep, the appetite and excretions, return to their usual state, and 



INSANITY. 57 

delirium does not lessen, or moral sensibility does not manifest itself in the 
same proportion ; monomania and mania, pass into the chronic state, or dege- 
nerate into dementia. 

Sometimes insanity terminates, by the predominance of the absorbent sys- 
tem. The patients gain in flesh, and delirium is dissipated in proportion as 
obesity increases. Obesity continues for several months after the perfect re- 
establishment of reason ; whilst it is a sign of dementia, if the delirium per- 
sists. In the opposite class of cases, the patient is cured only after having 
reached the last degree of emaciation ; and only returns to life and reason, 
after having stood at the portals of death. For thirty years, this last critical 
termination was denied ; it being affirmed, that emaciation was the effect of 
insanity, and not its critical termination. However, there are many cases of 
intermittent insanity, whose course renders this mode of termination evident. 

Mad'e ***, fifty-one years of age, has had several attacks of insanity, as a 
result of severe afflictions. Each attack ceases, so soon as the patient be- 
comes lean in flesh. 

The intermission continues two years, during which she increases much in 
size, and when she seems to have attained the maximum of health, delirium 
suddenly bursts forth, is prolonged for many months, and its intensity lessens. 
only when emaciation begins. It ceases, only when she becomes very lean. 
I have often observed similar facts. 

M. ***j fifty-four years of age, has had a great number of attacks of mania 
with fury ; each attack lasts from fifteen to twenty days, and its termination 
announces itself by a great and rapid emaciation, while the return of the at- 
tacks occurs only when he has recovered a good degree of flesh. 

Galen cites a case of insanity, which was terminated by a quartan fever. 
Belgarric states a similar fact, in a thesis sustained at the school of Montpe- 
lier with this title: " An in ?iio7-bis chronicis, frhris sit rxcitancla" ? I have 
known in several instances, iusanity terminated by fevers, either continued or 
intermittent. 

Hippocrates, Celsus, Boerhaave and Lacutus, assure us, that insanity is 
terminated by hemorrhoids. Frederic Hofmann advised cups to the funda- 
ment to provoke them. Epistaxis also, has cured it. The first menstrual 
eruption is sometimes critical, while the cessation of the menses is a time, 
truly critical with some insane women. I have known many, who have en- 
tirely recovered the use of their reason, on ceasing to menstruate. The re- 
establishment of the menses, very often terminates insanity. Uterine hemor- 
rhages, leucorrhcca and blermorrhagia, have also produced it. Coition and 
the spermatic excretion, have been critical. So have gestation and lactation; 
but I think it unwise, to advise marriage for the cure of insanity. 

This means does not succeed so often as is supposed ; and sometimes aug- 
ments the evil. 

I have known a great number of monomaniacs, and those afllicted with ma- 
nia, whose mental state was not improved by pregnancy, parturition nor lacta- 
tion. 

Cutaneous aflfections merit our attention the more, from the fact that their 
suppression causes insanity ; and because the insane are very subject to them. 
I shall refer elsewhere to the course of the pelagra, and its peculiar influence 
upon suicide. Sometimes insanity re-appears, at the same time that tetters 
appear; whilst more 'frequently, it ceases only when the tetter disappears; 
and the cure is not permanent, except when this form of eruption is fixed upon 
some part. 

Hippocrates was of opinion that psora terminates insanity, and all those 
who have seen much of this disease, coincide with him in opinion. I endea- 
vored to communicate it to a soldier, paralytic and in a state of dementia, in 

8 



58 INSANITY. 

consequence of a repercussion of this disorder, but succeeded neither in cur- 
ing him, nor in communicating the disease. 

Gardanne pretended, that we could cure insanity, by the inoculation of the 
small pox. Turuncles, which produce a suppuration more or less abundant, 
often terminate insanity ; whilst eschars, and enormous, but atonic suppura- 
tions, never bring it to a favorable issue. Ulcers, whose suppression causes 
insanity, cure it, by being reestablished ; as art cures, by recalling habitual 
evacuations, that have been suppressed. 

Perfect and Pinel, mention the cure of a maniac, after the engorgement of 
a parotid. In 1812, there was at the Salpetriere a woman forty years of age, 
who, frightened by a thunder-clap, became a maniac. The mania ceased in 
consequence of an enormous engorgement of the submaxillary glands. This 
patient fell into a profound stupor, which was dissipated, in proportion as the 
engorgement of the glands disappeared. 

Lafontaine read to the society of Gottingen, the history of an insane per- 
son, who was cured, after many years, by the extirpation of a cancer of the 
breast. 

Salivation is a very frequent symptom with the insane. Many make efforts, 
as if desirous to spit, but without success. 

This symptom depends upon constriction of the throat, or spasm of the 
salivary glands. It happens, however, that salivation is critical, as Perfect and 
Rolfinck have observed, as w^ell as Pinel and myself 

The discharge of tears offers also the same characters. Many insane per- 
sons appear to weep without shedding a tear. The paroxysms often cease, by 
the shedding of tears, which in some cases, are critical. The return of trans- 
piration, terminates insanity much more frequently than is supposed. It is 
this, Avhich renders the spring favorable to the cure of this malady ; and the 
tepid baths so useful in the treatment of the insane, whose skin is in a state 
of remarkable erethysm. 

The vomiting of mucous, yellow, black or pitchy matters, and alvine de- 
jections of the same nature, often terminate insanity, especially lypemania. 
Hippocrates, Lorry and Pinel, have pointed out these terminations, as well as 
Mead, Selle, and Van Swieten, who have, besides, recorded cures which had 
taken place after the expulsion of worms. During the year 1811, we had at 
the Salpetriere several maniacs, who were cured by the expulsion of worms. 

However, I am far from attributing to the presence of worms, that impor- 
tance in the production of insanity, which Prost gives to it.* 

The same is true of the influence which this physician accords to the mu- 
cous membrane of the alimentary canal. To conclude from the fact that in- 
sanity is terminated by alvine evacuations, that it has its seat in the intestines, 
is strangely to deceive ones-self 

To conclude also, from the fact that the mucous membrane of the intes- 
tines is phlogosed and ulcerated, that insanity has its seat in the intestinal 
mucous membrane, is equally to deceive ones-self It is to confound effects 
with causes. Intestinal evacuations are critical, in a great immber of affec- 
tions, which evidently have their seat elsewhere than in the mucous mem- 
brane of the intestines. 

In hypochondria, whose seat is so often in the abdominal viscera, we avoid 
purgatives. We prescribe them in insanity, to provoke a new centre of irri- 
tation, to excite the abdominal viscera now fallen into alony, and to expel the 
accumulated matters from the alimentary canal. The administration of pur- 
gatives is not always followed by a cure ; indeed, it is often prejudicial. 

Phlogosis, and ulcerations of the mucous membrane of the alimentary ca- 

** A glance at insanity, Paris, 1807; in 8vo. 



INSANITY. 59 

nal, prove no more that it is the point of departure in insanity, than that it is 
the seat of phthisis. 

The insane become enfeebled progressively ; and tolerant also, of every 
variety of chronic inflammation. They are scorbutic, and phthisical. A 
great many of them succumb to marasmus, after having had serous, sangui- 
neous, and purulent evacuations. 

How often, on opening a dead body, do we find the mucous membrane of 
the intestines injected, thickened and disorganized ? 

We ought to have observed a great number of the insane, to have followed 
throughout their course, the maladies to which they yielded, and to have com- 
pared the results of autopsies, with the symtoms which had characterized the 
insanity and last malady, before drawing general conclusions. 

The different forms of insanity terminate in each other. Thus, mania ter- 
minates in dementia, or lypemania ; and mania with fury, terminates critical- 
ly by dementia, when the latter is the product of too active medication, at the 
commencement of mania or monomania. All forms of insanity degenerate 
into dementia, after a more or less brief period of time. 

There are individuals who, after being cured of insanity, are hypochon- 
driacs and hysterical. I have never known epilepsy cause insanity to cease. 
In some cases, it unexpectedly succeeds convulsions, which resemble epilepsy ; 
but these convulsions, far from being critical, announce an intracranial lesion, 
which aggravates the evil, and presages the approaching end of the patient. 

I speak not of accidental crises, which can furnish no therapeutic indica- 
tion, such as falls upon the head, poisoning, cutting the hair, castration and 
the operation for cataract, which have sometimes brought insanity to a favora- 
ble close. 

Cannot moral affections, by reacting upon the sensibility, by modifying the 
sensations, ideas, passions and determinations of the insane, become critical 
in insanity, of which they are so often the cause ? Have not an unforeseen 
enjoyment, or an unexpected success, caused the gravest maladies to cease ? 
Has it never happened, that a sudden fright, or violent mortification, has ter- 
minated maladies, supposed incurable ? Do not these troubles, which entirely 
overcome the moral man, resemble in any respect those tumultuous move- 
ments, which precede physical crises ? 

A young lady is plunged into the profoundest melancholy, because she can- 
not be immediately married to her lover ; she refuses every kind of nourish- 
ment, and falls into marasmus. After some months, her lover presents him- 
self to her with an assurance of their speedy marriage. The patient is re- 
stored. 

An insane person refuses every variety of nourishment. A sense of honor 
forbids him to eat. After many days, vainly employed in persuading him of 
his error ; to overcome his resolution, they presented to him a fal^c patent, 
signed Napoleon, which commands him to eat, and acquits him of a breach of 
honor, if he obeys. The patient takes the ordinance, and reads it several 
times. A moral conflict arises between his convictions, and the order which 
he has received. After a struggle of many hours, he yields with a groan ; 
eats, and is restored to health. 

A young man, in despair that general Moreau had been condemned to ex- 
ile, persuades himself, that he is destined to avenge this injury, done to the 
French nation, in the person of its first general. 

At Cadiz, whither commercial affairs had called him, he indulges in ma- 
niacal acts, wanders about the city armed, requiring himself to be recog- 
nized as the chief of the French nation. He is arrested and sent back to 
France. During the long voyage, M. * takes for a guard of honor, the sol- 
diers who accompany him. He arrives at Paris. Besides his pretensions, the 
patient persuades himself that one of his relatives, — his most intimate friend. 



60 INSANITY. 

— has become his most cruel enemy, and is opposed to his elevation and de- 
signs. Some months pass in retirement, and the use of an appropriate regi- 
men. At length, after six months, this friend, the object of such intense an- 
ger, presents himself He is assailed with abuse and threats, which do not 
prevent him, however, from throwing himself into the arms of his sick ac- 
quaintance. They remain in each others' embrace for some minutes. Tears 
flow, the patient turns pale, falls, unable to sustain himself, and is restored 
to reason, which has ever since maintained its supremacy. 

A man of letters goes to drown himself, and is met by robbers. He suc- 
cessfully defends his purse, and returns home, perfectly cured. Do not these 
facts present the character of a crisis from a violent effort, and a radical 
change in the sensibility ? 

But shall we admit the existence of this moral influence, when insanity de- 
pends upon the alteration of the humors, or a disorder of every other system 
but that on which innervation depends ? 

Why not, when there are no grave lesions in the organs 1 Moral impres- 
sions determine a movement, a kind of shock in the fibres ; the forces are 
modified ; and the organs acquire an activity, adequate to the solution of the 
maladies. 

Fear and dread, cause involuntary evacuations, both of the rectum and blad- 
der ; anger provokes hemorrhages, and a bilious flux ; rage augments the sali- 
vary secretions ; joy awakens the tender emotions of the heart ; mortification 
causes the tears to flow. 

Why refuse to moral affections an influence, in the solution of insanity, 
when we accord to it, one so powerful, in the preservation of health, and in 
the production of disease, particularly cerebral disorders ? 

A lady nineteen years of age, of a sanguine temperament, having never ex- 
perienced the slightest contradiction, was very choleric and of an extreme sus- 
ceptibility. Although apparently well, her menses were irregular. At the ap- 
proach of her menstrual periods, or when she experienced some opposition to 
her desires, which were always imperious, she became peevish, difficult, and 
reserved. She complained of head-ache, and of weakness in her limbs. On 
the slightest provocation she became irritated, and vexed ; giving herself up 
to the blindest acts of ano-er. She abused her mother and friends, threatens 
their lives and her own. After each attack of furious anger, Madame *, fell 
into a state of prostration, but was, at length, restored to a calm state, both of 
body and mind. 

If she sought to control herself, and to restrain the explosion of her anger, 
she suffered dreadfully in all her members. Her head was puffed up, her face 
injected, and her eyes gorged with blood ; and this condition was relieved, 
only by the occurrence of a paroxysm. 

Does not this observation, whose details will find a place elsewhere, strength- 
en our opinion, respecting the moral crises of insanity ? This opinion is con- 
firmed, by the salutary effects which are obtained from moral agencies, in the 
treatment of mental alienation. Here, as in the physical treatment, the phy- 
sician can only imitate nature, and second its tendency, towards this or that 
solution. 

The study of the critical terminations of mania, conduct us naturally to 
considerations respecting the curability and mortality of this malady. 



INSANITY. 



61 



TABLE OF CURES. No. VIII. 



England. 

Bedlam hospital, from 1748 to 1794, 

in 1813, 
St. Luke's hospital, from 1751 to 1801, 
York hospital. 
Retreat near York, from 1801 to 1814, 

Totals, 



Admissions. 


Cures. 


8874 . . 


. . 2557 


422 . . 


. . 204 


6458 . . 


. . 2811 


599 . . 


. . 286 


163 . . 


. . 60 


16516 


5918 



France 



Charenton, from 22d Nov. 1798, to 22d 




July, 1800, 97 . . 


. . 33 


Do. in 1803, 499 . . 


. . 161 


Salpetriere, 1801 to 1805, 1002 . . 


. . 407 


Do. 1804 to 1813, 2005 . . 


. . 1218 


My own Establishment from 1801 to 1813, 335 . . 


173 



Totals, 



39;38 



1992 



TABLE OF CURES OBTAINED AT THE SALPETRIERE DUR- 
ING TEN YEARS. 

-o 5S lears. 

1 1 , ^ . 

<^ 1804 1805 1806 1807 1808 1809 1810 1811 1812 1813 1814 

209 64 47 7 4 3 2 1 1 

212 — 73 54 4 2 2 1 1 

206 — — 78 49 10 3 1 1 i 

204 — — — 60 55 11 1 2 

188 — — — — 64 57 4 2 1 2 

209 — — — — — 48 64 9 4 1 3 

190 — — — — — — 48 51 7 1 3 

163 — — — — — — — 44 30 8 3 

208 — — — — — — — — 75 41 11 

216 — — — — — — — — — 50 49 



a 



129 
137 
143 
129 
130 
129 
110 

85 
127 

99 



2005 



1218 



From the reports made in different establishments or hospitals for the in- 
sane, we conclude : 1, that the absolute cures of the insane are about one 
third.* 2, that the number of cures varies from a fourth to a half This 
difference depends upon the peculiar circumstances, of locality, maladies, and 
treatment. 3, that the cures are more numerous in France than in England, 
(they are much more rare in Germany and in Prussia). Thus, whatever dis- 
play the English may make of their success in the treatment of the insane, 
we can oppose to it still greater success in France. 

* In the establishment of Ivry, we enumerate among 529 insane of the two sexes, not 
paralytic, 263 cures=l to 2.01. 



\ 



U 



•O. 



62 INSANITY. 

A word of information this to such of my countrymen, as think that the 
better, must be always among strangers. 

It is not sufficient to determine the number of cures. It is of importance 
moreover, to ascertain the duration of mental alienation, or of its treatment. 
It is with this view, that I have arranged the second table, embracing a list of 
cures during ten years. 

The first column presents the number of admissions, a deduction being 
made of the incurables ; the horizontal lines, indicate the cures of each year ; 
the second vertical column indicates the total number of cures. 

I have constantly observed, that in the course of the first month of the dis- 
ease, a strikingly marked remission takes place. The insanity, which, up to 
that period, had an acute and violent course, seems to have reached its close ; 
and it is, at this time, that it seems to pass into a chronic state, because the 
crisis is incomplete. 

Ought this remission, which I have observed with the greatest care, to be 
attributed also to the symptoms which complicate insanity at its commence- 
ment ? It is often during the first month, that we obtain the greatest number 
of cures, when compared with the following ; a fact which confirms the cor- 
rectness of the Memoir, read by Pinel before the Institute in 1806. 

The mean^erm of the duration of insanity has been fixed in this memoir, 
at between five and six months. M. Pinel has excluded from the estimates 
which led to this result, all those who had been elsewhere subjected to treat- 
ment, as well as those whose insanity was of long standing. Mr. Tuke gives 
a greater extension to the duration of insanity, in the account which he ren- 
ders, of the Retreat near York. Our data oblige us to range ourselves in 
opinion with the latter. I was led to this conclusion, by making up the report 
of the insane women, admitted at the Salpetriere, during ten years. This re- 
port extends from 1804 to 1813. There were received, during this period, 
two thousand eight hundred insane women. Seven hundred and ninety-five 
were regarded as incurables, in consequence of their age, or because they 
were imberiles, epileptic or paralytic. 

Two thousand and five were put under treatment, without reference to the 
duration, or character of their insanity. Of this number, six hundred and four 
were cured during the first year, five hundred and two the second, eighty-six 
the third, and forty-one in the seven following years ; whence we may con- 
clude, 1st, that we obtain the greatest number of cures during the first two 
years ; 2d, that the mean term of cures, is a little less than one year ; 3d, that 
after the third year the probability of a cure is only as one to thirty. There 
are however examples, which prove that we ought never to despair of the cure 
of the insane. 

Pinel, after Baumes, cites the memorable example of a lady, who had pass- 
ed twenty-five years in a state of mania, as was known to a whole province, 
and who suddenly recovered her reason. I knew a girl who, for ten years, 
was in a state of dementia, with suppression of her menses. One day on ris- 
ing, she runs to embrace her mother ; saying, " oh ! mamma, I am cured" ! 
Her menses had just commenced flowing spontaneously, and reason was im- 
mediately established. But these cases are rare. 

They prove, that when there are no marked indications of incurability, or 
when no physical disorder exists, we may hope, that at length, insanity will 
cease. I have seen it twice terminate at the critical period, with two women, 
who had been insane, and even in maniacal dementia from their earliest youth. 
There was at the Salpetriere, while I was physician at that hospital, a woman 
who had become insane at her first menstrual period, and who was cured at 
forty-two years of age, at the disappearance of the menses. 

The greater number of cures are obtained in spring and autumn. 



INSANITY. (33 

The age most favorable for cure, is from twenty to thirty years. Passed 
fifty years the cures are rare. 

Mania and monomania, are much more frequently cured than lypemania. 
We never cure idiocy nor senile dementia. Chronic dementia is rarely cured. 
Mania is cured more promptly than lypemania. There are many insane per- 
sons, who can be restored only to a certain point. 

Those individuals retain such a degree of susceptibility, that the sliirhtest 
causes provoke relapses, and they preserve their reason only by being remov- 
ed from society, to a place where no moral shock, no disquietude, no event 
exposes them to relapse into their former condition. There are others, whose 
brain, and consequently the reason, has experienced such a shock, that they 
can no more act the part which they were formerly accustomed to perform iii 
society. 

They are very rational, but do not retain mind enough to be military cha- 
racters, to conduct their commercial affairs, or to control successfully their 
private business. We may estimate these individuals, at one twentieth of the 
number, who recover their reason. 

The greater part of the insane retain a painful recollection of their malady. 
They are often ungrateful for the attentions which they have received, be- 
cause they imagine that they are despised on account of their malady, and 
that they have been removed from society, isolated, and treated at an impro- 
per time. This phenomenon, which has been noticed by the ancients, and 
which is usually very marked during the earlier periods of convalescence, is 
dissipated by degrees, and disappears at length, when the individuals have 
recovered their full measure of health. 

Almost all the insane, even maniacs, have a recollection of their ideas, illu- 
sions, false judgments, and affections, whatever may have been the disorder of 
their intellicrence. 

When they become convalescent, they render a very good account of their 
illusions and hallucinations ; of their repugnances, and aversions ; of their 
preferences, and obstinacy ; in fine, of the motives of their determinations 
and acts. 

They determine with great accuracy the epoch of the cessation of the de- 
lirium. They indicate the causes that have produced it, or the symptoms that 
have signalized it. They appreciate the attentions that have been paid them, 
the good or the evil that they have done, and the errors or faults, -which they 
have committed during the existence of their malady. Insanity is not, there- 
fore, attended by loss of consciousness, for the insane man often preserves the 
recollection of his condition. 

Many melancholies and even maniacs, have a perfect knowledge of all their 
discourses, and of all their actions, and after their cure, they relate with sur- 
prising exactitude, what they have done, said, or thought. Many, in conse- 
quence of the recollection which they preserve of these things, dare not ap- 
pear in public, to renew their former relaticms, fearing that in entering into 
the world, they shall become objects of curiosity, of commisseration and dis- 
trust, which wounds their self-love and humbles them.* 

*I have reported, in the "Annals of public hygiene and legal medicine," 1636, t. 
XVIth, page 197, the psychological condition of a hypochondriacal lady, from extracts of 
letters which were addressed to me by the patient. All the symptoms which this lady 
experienced, were set forth, and analyzed by her, with remarkable correctness. 

In the same volume of the Annals, may be found a memoir of Doctor Bergmann, 
where are recorded the reflections of a person who, having been afflicted with mania, 
relates all that he experienced during his sickness. 

M. Leuret, in his " Psychological Fragments on Insanity,'" Paris, 1834, in 8vo. p. 25. 
has published the history of a maniac whom he saw at Ivry ; a maniac, who could re- 



64 INSANITY. 

It is not uncommon, that individuals who are regarded as cured by their 
relatives and even physician, are not entirely so. 

They reason perfectly well, have returned to their former habits and mode 
of living, and even discharge important duties, whilst there still remains some- 
thing peculiar, strange and unnatural. 

A gentleman, whose malady had been characterized by hallucinations of 
hearing, although perfectly restored to reason, experienced still the same hal- 
lucinations. But this symptom was fugacious, and the convalescent very well 
understood the cause of it. It persisted for four months. 

M. N. had been cured of lypemaniacal mania, had returned to his family, 
and been appointed to distinguished trusts, the duties of which he fulfilled in 
a remarkable manner. 

For a year, he was unwilling to turn his attention to an estate, in which he 
was much interested, to correspond with reference to it, to admit of conversa- 
tion on the subject, or to permit his wife and children to visit it. It was on 
this estate, that his delirium had first burst forth, with the greatest violence. 

A lady, cured apparently of an attack of suicidal lypemania, with parox- 
ysms of mania, passes a month in Paris, to divert her mind, and confirm 
her convalescence. She then returns to her family, and all her former habits. 
Every one is convinced of her perfect restoration to health. 

A year after, her husband was seized Avith an alarming attack of apoplexy. 
The grief she experienced in consequence of it, produced a profound impres- 
sion upon her mind, which resulted in her cure. Up to this period, she had 
led a very retired life, with irrational notions, from which, the care she had 
taken of her children, to prevent the effect, which their untimely death would 
have produced upon the mind of their father, alone relieved her. 

Mad'e N., after having been distres.sed for many months, by a gloomy and 
insane jealousy, which had impelled her even to wish to destroy her children, 
was unwilling to see them for eight months after her apparent cure, although 
enjoying the perfect use of her reason, and restored to society, where she was 
distinguished, as well by her wit, as her extraordinary personal charms. 

The cases which I have above reported, prove to a demonstration, that we 
cure a greater number of the insane than formerly. But the relapses ! the re- 
lapses are so frequent ! is repeated on all sides. 

So true is it, that it is as difficult to dissipate apprehension from the mind 
of man, as to establish hope in his breast. We must not confound relapses, 
with new attacks of insanity. 

Of two thousand eight hundred and four insane persons, treated at the Sal- 
petriere, two hundred and ninety-two were there, for a second or third attack. 
We may thus conclude, that one tenth of the cases are relapses. Among the 
wealthy, relapses are less fretpient ; without doubt, because they have more 
means at their control, and a greater desire to avoid the causes of a relapse, 
while the misery and indifference of the poor, expose them to the action of 
every malign influence. 

Physicians know well, that those who have had fevers, the phlegmasia?, etc. 
are, more than others, exposed to a recurrence of the same maladies ; because 
an organ, once affected, is, from this circumstance, more disposed than an- 
other, to be affected anew in the same manner. 

We give not the title of relapse, to a recurrence of these maladies. Why 
give it to a new attack of insanity ? Do not all hospital physicians see 
frequently returning to their wards, the same individuals, and for the same 
causes ? 

call, two days after he had uttered them, words altogether incolierent, and wliich a man, 
enjoying the use of his reason, unless endowed with an extraordinary memory, would 
have foimd great difficulty in recollecting. 



INSANITY. 65 

They consider themselves as about to treat a new malady, and not a pre- 
ceding one, that had been cured. 



I do not deny, that the insane are subject to relapses. They are perahps 
more exposed than other classes of patients ; because the exciting causes of 
insanity are numerous, and appear every where, and in all the circumstances 
of life ; because the crises of this malady are less complete ; and because 
individuals who have been cured, are less cautious in guarding themselves 
against accidents, which have produced their former attacks. 

But because men are imprudent, ought we to censure the impotence of 
medicine 1 I add, that relapses are often foretold ; and that they might, fre- 
(juently, have been prevented. 

Greding, Monro, and Crichton, are of opinion, that the insane are not long 
lived, even those who have recovered the use of their reason. To a certain 
extent, I participate in this opinion ; but I do not go beyond them, as Doctor 
Andre has done in a German Journal. 

In opposition to this afflictive decision, experience proves, that many insane 
persons lead a long life. It is not rare to find in hospitals, insane persons 
who have lived there twenty, thirty and forty years. 

The mortality of the insane presents several interesting considerations, al- 
though neglected hitherto. It ought to be studied with reference to the 
number of the insane, to the season, age, sex, and form of insanity ; to the 
malady under which the patients succumb, and to the appearances presented 
on dissecticMi. 

The mortality of the insane, like their cure, depends upon many local cir- 
cumstances. 

Both jone and the other are modified by the position, and general arrange- 
ments of the place in which they are treated ; by the direction, supervision, 
and regimen ; as well as by the variety of patients received at the establish- 
ment. The mortality must be more considerable, and the cures less frequent, 
when we have to treat every form of insanity. Thus, the tables of mortality, 
published by the physicians of London and York, are the more favorable, be- 
cause they receive at those hospitals those individuals only, who offer the most 
favorable indications for a cure, and consequently, most widely removed from 
mortality : whilst at the Salpetriere, Bicetre, and Charenton, more than one 
third of the insane admitted, come to terminate their existence at these hos- 
pitals. We must also take notice of the accidental circumstances which mo- 
dify the mortality. Thus, we have observed at the Hotel-Dieu of Paris, that 
when the small pox was epidemic, a greater number of the insane died. 

In 1793, scarcity augmented the mortality among the insane at the Bice- 
tre (Pinel).* 

The mortality is greater in autumn and winter, as the following table (page 
68) proves ; whilst in spring and summer it is less. In the latter seasons, the 
means of preserving life, concur in warding off dangers. The insane are less 
confined than in winter ; they take more exercise ; partake of fresh vegetables ; 
and are more cheerful and gay. 

Thus, spring is doubly favorable to the insane ; since a greater number are 
cured, and less die than at other seasons ; a consideration, which furnishes a 
valuable indication for the direction of the insane, and a strong objection to 
debilitating treatment. 

We have seen that the age most favorable to the production of insanity, is 
from twenty-five to thirty-five years, for both sexes. The same is not true of 
their mortality. 

* In 1832, the cholera having invaded the division of the insane at the BicdTtrp and 
Salpetriere, the mortality among this class, at the two hospitals, was more considerable 
than usual. This scourge spared the hospital at Charenton. 

9 



66 INSANITY. 

This is highest for the two sexes from thirty to forty years, while that of 
women is highest from forty to fifty years ; and that of men from thirty to 
forty. It is higher among women than men, from sixty years and upwards. 
It results, therefore, from the table above referred to, that the mortality of the 
insane takes place at an earlier period among men, and is far greater at an 
advanced period of life, among women. 

We ought also to take notice of the treatment, in order correctly to appre- 
ciate its effects. The mode of treatment adopted at the Hotel-Dieu, rendered 
the mortality of this hospital greater than it is at present, at the Bicetre and 
Salpetriere. 

At Marseilles, Raymond found the mortality of the insane to be as one to 

fourteen. 

Tenon, at Paris, in 1786, fixed it at one to eleven. 

Pinel, setting aside cases of senile dementia, estimates it at one to twenty 
or twenty-three. 

I believe that it is higher. It is as one to six or eight. 

But to have more precise ideas on the subject, we must consider it, with 
reference to the various forms of insanity. 

My records furnish the following : 

Mortality in mania, one to twenty-five. 
Mortality in monomania, one to sixteen. 
Mortality in lypemania, one to twelve. 
Mortality in dementia, one to three. 

Imbeciles and idiots are never cured, but some of them live a long time. 
It is rare, however, that they survive their thirtieth or fortieth year. 

Accidental acute mania is rarely fatal ; simple lypemania, even that which 
is characterized by an impulse to suicide, is mortal only when it depends 
upon an organic lesion, or is complicated with scrofula, phthisis and paralysis. 
The patients then fall into marasmus, (tabes melancholica of Lorry), and die. 

Dementia, being the termination of all forms of mental alienation, is most 
commonly fatal. It is often complicated with paralysis ; and it is this com- 
plication, which renders the mortality of the Bicetre and Salpetriere, so much 
greater, as they are the receptacles of every form of insanity. The mortality 
of the insane is greater during the first two years after the invasion of the 
malady, than the following. It is greatest during the first year after their 
admission, among our women at the Salpetriere. 

These considerations lead us to the study of those maladies to which the 
insane succumb. 

Those which most frequently terminate the existence of the insane, are in- 
flammation of the meninges, cerebral fever, apoplexy, organic lesions of the 
brain, and of the thorax or abdomen. 

We may estimate two eighths of encephalic affections, (excepting epilepsy 
and paralysis from the number of maladies which destroy the insane), two 
eicrhths of disorders of the thorax ; and three eighths of abdominal complaints, 
colnprising among them, colliquative diarrhoea ; and marasmus without orga- 
nic lesion. 

Monro, on the authority of the aphorisms of Greding, assures us that ma- 
rasmus and dropsy of the chest occasion the greatest amount of mortality 
among the insane. The examination of about six hundred bodies of the in- 
sane, has not led me to this conclusion. On the contrary, diseases of the tho- 
rax are less numerous than those of the abdomen. 

Does this difference depend upon climate and mode of living, or upon the 
mode of treatment employed to combat the disease ? 

A slow, nervous fever, often terminates lypemania. Some lypemaniacs re- 
fuse all motion. At one time they are unwilling to leave their bed; at another, 
they insist upon sitting on the ground. Some obstinately refuse every kind of 



INSANITY. " 61 

aliment ; others eat with frightful voracity. They seem to take a pleasure, in 
braving whatever can destroy their organization. They waste away. Their 
skin becomes earthy. They fall into a state of extreme debility. A parox- 
ysm of fever returns at every evening. A diarrhoea often supervenes, and 
hastens their doom. 

Phthisis, which complicates insanity, and more particularly lypemania, has 
been observed by Mead and Lorry.* 

In a great many cases of insanity, I have known lypemania and even mania, 
preceded by many months, by phthisis, or appear at the same time with it. 
These cases of phthisis, escape the notice of the most careful observers. 
Th« patients become more and more feeble ; fall into marasmus, and a slow 
fever ; attended sometimes with cough, and diarrhoea. At length they die. 
The delirium, far from ceasing, augments, even to the end. 

At the opening of the bodies, we find the lungs tuberculous, suppurating, 
and sometimes with vomices. Melanosis of the lunss is not rare. The 
intestines, almost always, present traces of inflammation and gangrene ; as 
well as suppuration of the crypts of the mucous membrane. 

It might be supposed that organic lesions of the lung existed, because the 
insane cry and use this organ in their vociferations. It is not so ; since 
phthisis is generally observed only among lypemaniacs, who never vociferate. 

Hippocrates informs us in the Coacs, that the phrensy which supervenes 
upon pleurisy, is fatal. Sometimes also, insanity alternates with phthisis, and 
while the delirium lasts, even in its most violent form, the symptoms of phthisis 
cease to appear. 

Scurvy is still one of the most frequent complications of mental alienation. 
It is often a result of insanity, of the insalubrity of the habitations, of the 
want of exercise, and the bad regimen of the insane. 

The scorbutic belonging to this class are either lypemaniacs, or in a state 
of dementia, and very often paralytic. It manifests itself by yellow, brown, 
or black spots upon the members, and the gums are fungous. These patients 
are seized with a serous and sometimes sancjuinolent diarrhoea ; the extremi- 
ties become oedematous ; pains and spasms of the stomach supervene ; and 
the face is pale, and swollen. 

Eschars upon the sacrum, heels, the malleoli, trochanters, and elbows, invo- 
luntary and serous dejections, and syncopes, presage approaching death. 

On opening the bodies, we find serous eftusions in the head, and the brain 
is infiltrated. The heart is flaccid, and often the capacity of the pulmonary 
ventricle, and particularly that of the right auricle, is augmented. The gall 
bladder is full of black and viscid bile. The spleen, more or less voluminous, 
is reduced to a condition resembling the lees of wine. The mucous mem- 
brane of the intestines is injected, and coated with a brown, sanguinolent mu- 
cosity. The muscles, pale and discolored, are torn with the greatest facility. 

Half of the insane, whatever may be the character of the delirium, but 
more particularly monomaniacs who die, are paralytic. 

These individuals suffer more or less embarrassment, in the articulation of 
sounds ; though their minds are sometimes but slightly deranged, at the com- 
mencement of the malady. After some months or a year, if they have not gain- 
ed in flesh, they become very lean, grow feeble, walk with difficulty, and incline 
ordinarily to the left side. The dejections become involuntary, without being 
more liquid. There is incontinence of urine ; embarrassment of speech in- 
creases ; and the vital forces diminish, although they may take exercise, and 
the appetite be voracious. 

From the time that they take their bed, gangrenous eschars form at the coc- 
cyx, or the trochanters, heels and elbows. This humid gangrene makes ra- 
pid progress, and the bones are soon denuded. Fever sets in. Epileptiform 

* De melancholia et morbis melancholisis, Parisiis, 1763, t. I. p. 385. 



68 



INSANITY. 



convulsions supervene ; the members are livid, and very cold ; the pulse is no 
longer perceptible, and the patients die. 

I have pointed out these two terminations, because I have very often observ- 
ed them. 

Apoplexy is still one of the maladies which terminates the life of the in- 
sane. Of two hundred and seventy-six individuals, thirty-seven died apoplec- 
tic. Pinel the elder, has noticed this variety of sudden death, by which some 
maniacs and monomaniacs are overwhelmed, particularly during the winter. 
Aged persons are more exposed to it than the young. Suddenly, the most 
violent fury, and the wildest delirium cease ; and in a few moments the patient 
dies. It would seem that all the vital forces had been exhausted, by the .ex- 
cess of maniacal excitement. 

I had in charge an old man seventy-two years of age, dry and lean, who, 
for three months, was in a constant state of agitation and delirium. He comes 
out of this state, and in the calmest tone, asks his servant for his snuff box, 
takes from it a pinch of snuff, and expires. 

Putrefaction of the body speedily ensued, and the interior of the cranium 
presented no alteration. M. ***", forty-three years of age, of a dry tempera- 
ment, suffered for a month, from an attack of delirium, with fury. On the 
thirty-first day, we noticed that he was pale. He asks to sit down, and ex- 
pires. I found in the duplicature of the falciform fold of the dura mater, an 
osseous, pisiform substance about three lines in diameter, depressing the cor- 
responding convolution of the brain. In other cases I have found nothing. 



TABLES RELATING TO THE MORTALITY OF THE INSANE. 

No. 1. Mortality relative to admissions. 



Admissions 
Bicetre, from the year 1784 to 1794, 1405 

Salpetriere (Pinel), from 1801 to 1805, 1002 

Charenton, during the year 1803, 499 

Salpetriere, from 1804 to 1814, 2804 



Deaths. 
685 
250 
82 
790* 



No. 2. Mortality relative to Seasons. 

During the ten years, from 1804 to 1814, the 790 deaths at the Salpe- 
triere, presented the following proportions, relative to seasons : 

March, April, May, . . , . . 175 

June, July, August, - - - - - 174 
September, October, November, .... 234 

December, January, February, ... 207 



790 



Mortality with respect to Age. 

I have here compared the mortality of men with that of women, relative 
to age, during an equal number of years, and from a nearly equal number of 
deaths, of the two sexes. 
Bicetre ; Men, from 1784 to 1794. Salpetriere ; Women, from 1804 to 1814. 



20 


years, 


30 




40 




50 




60 




70 





and above, 



- 25 
176 

- 215 
134 

- 90 
45 



58 
83 
143 
173 
123 
210 



685 790 

* The 790 deaths at the Salpetriere, from 1804 to 1814, relative to admissions, took 



INSANITY. • 69 

TABLE OF MORTALITY 

At the Salpetriere, during ten years. 

No. of ad- Years. i^ 

missions r- ^ — • ->, §■ 

each year. 1804 1805 180G 1807 1808 1809 1810 1811 1812 1818 ^ 

271 46 21 15 8 1 6 2 1 1 1 102 

301 — 48 29 16 7 2 4 1 2 109 

292 _ _ 49 22 9 2 1 4 2 1 90 

297 ___ 64 25 3 2 2 4 1 101 
252 _ _ _ _ 35 23 8 I 3 1 71 

299 _____ 35 31 7 3 1 77 

260 ______ 30 22 9 3 64 

233 _______ 26 20 9 55 

301 ________ 23 10 33 

298 _________ 26 26 



2804 728 

Those who died during this period, but who were admitted before 1804, 52 



Total, ...... r .. . 780 

List of Diseases, which terminated the existence of the Insane. 

Adynamic fever - - - - - - 32 

Ataxic fever, - - - - - - 14 

Cerebral fever, - - - - - - 28 

Slow nervous fever, ----- 25 

Pleurisy, - - - - -' - - 12 

Phthisis, ....-- 28 

Latent Peritonitis, - - - - - - 13 

Colliquative diarrhoea. Scurvy, - - - - 38 

Hydropericonditis, - - - - - -11 

Scirrus of the pylorus, ----- 4 

Organic lesions of the liver, - - - - 35 

Apoplexies, __---- 33 

Epilepsies, -------4 



Total ------ 277 

We are now naturally conducted to the post mortem examinations of the 
insane. 

From this announcement, every one doubtless expects, that we are about to 
point out the seat of insanity, and to make known the nature and seat of the 
organic lesion, of which insanity is the expression. 

This we are by no means to accomplish. The examinations of the dead 
have, to the present period, been barren of practical information. 

The facts observed by Willis, Manget, Bonet, Morgagni, Gunz, Meckel, 
Greding, Vicq-d'Azyr, Camper, Chaussier, Gall, etc., have produced only ne- 
gative, or contradictory results. 

These distinguished observers had but few subjects submitted to their re- 
searches. 

All the labor that has been expended upon the anatomy of the brain, has 
produced no other result, than a more exact description of this organ, and the 

place in the following proportion ; 382, during the first year, 227, the second, and 181, 
during the seven following years. 



70 INSANITY. 

despairing certainty, of our beinoj forever unable to assign to its parts, the 
uses from whence we may derive information, with reference to tlie exercise 
of the thinking faculty, whether in health or disease. 

Before drawing any conclusions, from those organic lesions observed among 
the insane, will it not be well to acquaint ourselves with all the varieties, both 
of the cranium and brain, which are compatible with the integrity of the fa- 
culties of the understanding ? 

Would not this be the true point of departure, for all our pathological re- 
searches ? 

Now, says the learned Chaussier, there is no organ in which we find greater 
varieties, with respect to volume, weight, density, and in its respective propor- 
tions, than in the brain.* 

Have we carefully distinguished the results of concomitant maladies, or 
those diseases which terminate the life of the insane, from those which belong 
to mental alienation ? 

Organic lesions of the brain reveal themselves by other signs than insanity. 
Thus, chronic inflammation of the meninges produces compression, which 
reveals itself by paralysis ; cerebral hemorrhage is also manifested by paraly- 
sis. Tubercles, cancers, and softening of the brain, present peculiar charac- 
ters, which cannot be confounded with mental alienation. 

Have we reflected on the sudden and instantaneous cures of insanity ? It 
is in consequence of having neglected these considerations, that we reason so 
erroneously respecting the seat of this malady. The minute and detailed de- 
scription of the alterations, and organic lesions, observed in the post-mortem 
examinations of the insane, would be too long, and the less necessary, as they 
offer nothing of a satisfactory nature. 

In treating upon mania, monomania, etc., I shall speak of the examinations 
made upon the bodies of those who have died while suffering from these vari- 
ous forms of insanity. 

I shall in this place content myself with giving the conclusions which I 
have been able to draw, from post-mortem examinations hitherto made. 

I do not pretend, that they are mathematically exact ; but that they are in 
the main correct, with respect to the facts observed. 

1. Vices of conformation in the cranium, are met with, only among imbe- 
ciles, idiots, and cretins. 

2. Organic lesions of the encephalon and its envelopes, have been observed 
only among those whose insanity was complicated with paralysis, convulsions 
and epilepsy ; or rather, these lesions appertain to the malady which has 
caused the death of the patients. 

3. The sanguine or serous effusions ; the injections, or infiltrations, which 
we meet Avith in the cranial cavity ; the thickening of the meninges ; their 
adhesions among themselves, with the cranium and the gray substance ; the 
partial or general softening of the brain ; the density of this organ ; the 
fibrous, knotty, and cancerous tumors, observed within the cranium ; all these 
alterations indicate either the causes, or effects of insanity ; or rather the 
effects of a complication, to which the patients have yielded. 

4. The alterations within the thorax, abdomen and pelvic cavity, are evi- 
dently independent of insanity. These alterations may, nevertheless, indicate 
the source of mental alienation, by showing the organ primitively affected, 
which has reacted upon the brain. 

5. All the ororanic lesions observed among the insane, are found to exist 
among those, who have never suffered from chronic delirium. 

6. Many post-mortem examinations of the insane, have revealed no altera- 
tion, although the insanity may have persisted for a great number of years. 

* A brief exposition of the structure and parts of the encephalon. Paris, 1807, in 8 fig. 



INSANITY. 71 

7. Pathological anatomy, shows us every part of the eacephalon, altered, in 
a state of suppuration, and destroyed, without chronic lesion of the under- 
standing. 

8. From the above data, we may conclude, that there are cases of insanity, 
whose immediate cause escapes our means of investigation ; that insanity de- 
pends upon an unknown modification of the brain ; that it has not always its 
point of departure in the brain, but rather in the foci of sensibility, situated 
in different regions of the body; as disorders of the circulation do not always 
depend upon lesions of the heart, but upon those of some other portion oi' the 
vascular system. 

This conclusion will be opposed to those who pretend, by the character of 
the delirium, to be able to point out that portion of the brain which is disturb- 
ed : it will be opposed to those who believe that there is an ideal insanitt/, a 
form, which I nuist confess my inability to comprehend ; as well as those to 
which they give the appellation ; intellectual insanity ; insanity of the mind. 

I am not more fortunate, in understanding the various systems that have 
been devised, for explaining the delirium, and the symptoms of mental aliena- 
tion. 

Happily, this information is not indispensable to the cure of the insane. 

Let us study the causes, character, course, and terminations of insanity : 
let us endeavor rightly to appreciate the influence of physical, moral and in 
tellectual agents, over this disorder, and we shall discover the means, suited 
to combat it. 

To cure insanity, it is no more necessary to understand the nature of it, 
than it is to know the nature of pain, to employ successfully, calming and se- 
dative remedies. 



IV. PROGNOSIS OF INSANITY. 

In establishing the prognosis of insanity, it will be necessary to keep before 
the mind, the signification which I have given to the five forms into which I 
have divided it. Otherwise, I shall be found opposed to those with whom I 
concur in sentiment. ^^^^ ^/ 

Imbecility and idiotism are never cured. ^ ^ 

Monomania and lypemania are cured, when they are recent, accidental, and 
do not depend upon an organic lesion. 

Mania is cured more frequently than monomania and lypemania. >* 

Acute dementia is sometimes cured ; chronic dementia very rarely ; senile 
dementia, never. j 

Hereditary insanity is cured ; but relapses are more to be feared, than in 
accidental insanity. 

Chronic insanity is cured with difficulty, especially after the second year. 
This difficulty is proportioned to the time that the predisposing causes have 
been operating on the system, prior to the outbreak of delirium. 

Whatever may be its duration, we may hope for the cure of mental aliena- 
tion, so long as marked, yet curable derangements exist, in the functions of 
nutrition. 

Moral causes, which have acted suddenly, constitute a circumstance in favor 
of a cure ; but if their operation has been slow, a cure is effected with diffi- 
culty. 

Excessive study, when it produces insanity, may well occasion doubts re- 
specting a cure ; especially when with these excesses are connected errors of 
regimen. 

Insanity, which is caused or continued by religious notions, or by pride, is 
rarely cured. 



72 INSANITY. 

Insanity, maintained by hallucinations, is cured with great difficulty. 

That form of insanity in which the patients are aware of their situation, 
presents many difficulties, if not promptly cured. 

When the insane have recovered the integrity of the assimilative functions, 
appetite, sleep, flesh, etc., without any diminution of the delirium, we have 
little reason to expect a cure. 

When the sensibility of the insane is so much enfeebled, that the presence 
of the sun does not affect them ; that they lose the senses of taste and smell ; 
and remain unaffected by excesses of whatever kind, they can never be cured. 

Insanity is incurable, when it is the result of scurvy or of epilepsy. Its 
complication with these maladies and with paralysis, leads to inevitable death. 



V. TREATMENT OF INSANITY. 

It is, doubtless, less difficult to establish systems, and to imagine brilliant 
hypotheses respecting mental alienation, than to observe the insane, and put 
up with the disgusting circumstances of whatever kind, to which those are 
exposed, who would, by observation, study the history of this most serious in- 
firmity. 

The difficulty of catching the varied and fugitive forms of insanity, the 
savage rudeness of certain monomaniacs, the obstinate silence of some, the 
scorn and abuse of others, the threats and blows of maniacs, the diswustinw 
filthiness of imbeciles, together with the prejudices which aggravate the lot of 
these unfortunates, have discouraged those who wished to cultivate this 
branch of the healinw art. 

They shun the maniacs. They fear them, and leave them in their chains. 

Monomaniacs are a little less neglected. They submit more readily to ob- 
servation. Their delirium is more amenable to theories and explanations. 

But we must live with the insane, in order to obtain exact notions respect- 
ing the causes, symptoms, course, crises, and terminations of their malady. 
We must live with them, in order to appreciate the infinite cares and number- 
less detoils, which their treatment requires. How great the good which the 
patient d rives from friendly and frequent intercourse with his physician ! 
How valuable the lesson, which the latter acquires, relative to the influence 
of the physical over the moral man, and reciprocally ! 

In the gestures, movements, looks, and general aspect ; in his proposals, ac- 
tions, and shades of conduct which are imperceptible to others, the physician 
often derives his first thought, respecting the treatment which is suited to each 
patient committed to his care. 

Mental alienation offers three orders of phenomena, whether we study the 
causes which produce it, or the symptoms which characterize it. 

We have seen physical as well as intellectual and moral causes, acting upon 
the brain, sometimes individually, sometimes collectively, produce insanity. 
These causes have, now a general, now a local action ; now primitive and 
immediate ; now secondary and sympathetic. Their action varies with the 
individual cases, and their effects are diverse, and even opposite. 

We have seen physical disorders as well as moral and intellectual, marking 
all the periods of the malady, in degrees, more or less intense. We have 
sometimes seen nature herself, bear the whole burthen of a cure, and restore 
the patient to health, by means that had escaped the most practiced observers. 
Generally, mental alienation is terminated by sensible crises. It is not rare 
to witness surprising cures, which are produced by moral influences, either 
accidental, or otherwise. 

Thus, in a general view of the treatment of the insane, we should propose 



INSANITY. 73 

to ourselves, the removal of physical disorder, the aberrations of the under- 
standing and the disturbance of the passions. 

We must, therefore, skillfully control the mind and passions, and make a 
suitable use of the physical means, which ought to be employed in the treat- 
ment of the insane. We must never lose sight of the causes which have pre- 
disposed to, and provoked insanity ; nor by any means forget the habits of 
the patient, and the sickness which existed, previous to the appearance of 
mental alienation, and which ceased a little before, or at the moment of the 
attack. 

Among the ancients, the treatment of insanity was made to consist in the 
use of hellebore.* 

An accident was the means of proposing the bath of surprise. The dis- 
covery of the circulation of the blood, caused physicians to bleed largely. 
The humorists returned to the use of purgatives. The English vigorously 
employed the precepts which Areteus and Coelius had suggested, and of 
which Erasistratus and Gallienus had made a most happy application. They 
made a secret of them ; but Pinel made himself master of it, and changed 
the lot of the insane. The chains were broken, f the insane were treated 
with humanity, hope gained hearts, and a more rational system of thera- 
peutics, directed the treatment. 

It will often be necessary to vary, combine and modify the means employ- 
ed ; for there is no specific treatment of insanity. 

As this malady is not identical in every case ; as in every instance it de- 
pends upon difterent causes, and presents varied characteristics, and requires 
new combinations ; a new problem is to be solved, for every patient whom 
we are called to treat. 

I will limit myself to general considerations, which are adapted to all ; and 
will set a due value upon certain medicaments, denominated heroic. 

In the study of symptoms, we have seen that the lesions of sensations, to- 
gether with that of the association of ideas, and of the will, caused by defec- 
tive attention, produced, and kept up the delirium, as well as the perversion 
of the passions. 

Whatever can act upon the brain, either directly or indirectly, and modify 
the principle of thought ; whatever can control and direct the passions, should 
be the object of moral treatment. 

The first question that presents itself, is relative to isolation. Ought every 
insane person to be removed from all familiar scenes, his mode of life changed 
— separated from those with whom he has always lived, — placed in a situation 
altogether new, and committed to the care of strangers 1 

The English, French, and German physicians, agree with respect to the 
necessity and utility of isolation. 

Willis, who was so long known, and sought for, in consequence of his suc- 
cess in the treatment of insanity, was accustomed to remark, that foreigners 
were with more certainty cured, than the English. The same is true in 
France. 

The cures are more frequent among those patients who visit Paris from 
abroad, than those who reside at the capital. The latter are not sufficiently 
isolated. 

The first effect of isolation is, to produce new sensations, to change and 
break up the chain of ideas, from which the patient could not free himself. 

New and unexpected impressions strike, arrest, and excite his attention, and 

* Article Hellebore; Encyclop. Method, by Ph. Pinel. 

t Bicetre in 1792, or the abolishment of chains (Memoirs of the Royal Academy of 
Medicine, Paris, 1836, t. v. pag. 31.) 

10 



74 INSANITY. 

render him more accessible to those councils, that ought to bring him back to 

reason. 

Besides, from the moment that an insane man is shut out from the world, 
surprised, astonished, and disconcerted, he always experiences a remission, of 
great value to the physician, who then, finding the patient without preposses- 
sions, can more readily acquire his confidence. 

Isolation is not less useful, in combating the disorder of the moral affections 
of the insane. The disturbance unexpectedly occurring in the nervous sys- 
tem, changes the nature of the sensations, and often renders them pamful. 
The natural relations with the external world are no longer the same. Ex- 
ternally, every thing seems to be thrown into confusion. The patient who 
believes not that the cause of these phenomena is within himself, is at va- 
riance with all that he either sees or hears ; a circumstance which excites his 
mind, and places him in opposition to others and himself He persuades him- 
self that his friends wish to oppose him, since tihey disapprove of his errors 
and excesses. Not comprehending fully what is said to him, he most fre- 
quently misinterprets the language which is addressed to him :--proofs of the 
tenderest affection are regarded as injuries, or as enigmas which he cannot 
solve : — the most devoted attentions are vexations : — his heart, ere long, nour- 
ishes only distrust. 

The insane man becomes timid and suspicious. He fears every one that he 
approaches ; and his suspicions extend to those who were most dear to him. 
The conviction that every one is endeavoring to torment and slander him, to 
render him miserable, and to ruin him, in body and estate, put the finishing 
stroke to this moral perversion. 

Hence that symptomatic suspicion, which often grows up without motive ; 
sometimes, in consequence of necessary opposition, which increases by rea- 
son of the alteration of the intellectual faculties, and which is depicted so 
strikingly upon the physiognomy of the insane. 

With such moral dispositions, leave an insane person in the bosom of his 
family, and immediately this tender son, whose happiness once consisted m 
residing at home, will desert the paternal mansion. The despairing lover 
hopes, by his counsels, to bring back the wandering reason of her whom he 
adores. Her unfortunate condition renders the blow only the more severe. 

She who once loved him so tenderly, will now see in him only a wretch, 
who offers his attentions, only the better to betray. 

This friend, whose heart is weighed down with grief, hopes, by his affec- 
tionate attentions, to restore that sensibility and reason, which had been the 
source of his attachment and happiness. 

But soon, unhappy one, thou wilt be embraced in the general proscription ; 
and thy cares for thy suffering friend, will be but proofs, that thou also hast 
yielded to the corrupting influences of his enemies. 

What are we to hope for, if we change not the moral condition of that un- 
fortunate class, whose prejudices are so strongly excited ? 

Who of us has not experienced the difference which exists, between being 
deceived, thwarted and betrayed, by his neighbors and friends, and by those 
who are strangers to him 1 

This unfortunate man, suddenly becomes master of the world, gives out his 
sovereign orders, to all who surround him. He pretends to be blindly obeyed, 
by those who had ever yielded to his wishes, through respect or affection. 
His wife, children, friends and domestics, are his subjects. They have always 
obeyed ; will they now dare to be disobedient ? He is in his dominions, and 
commands, a despot ; aird he is ready to punish with the greatest seventy 
whoever shall dare to make the least remonstrance. What he wills is impos- 
sible ; suppose it is, he wills it ; and shall the will of the great be met by 
insurmountable obstacles ? The affliction of his family, the regrets of his 



INSANITY. 



75 



friends, the agitation of all, their deference for his wishes and caprices ; the 
repugnance of every one to oppose him through fear of exasperating his mad- 
ness ° do not all these serve to confirm this wretched man in his notions of 
power and domination ? Remove him from the seat of his pretensions :— 
take him from his home. Stripped of his empire and subjects, he will collect 
his thoughts, direct his attention to the study of himself in this new world, 
and to the establishment of relations with those around him. 

The cause of mental alienation often exists within the family circle. The 
malady originates from chagrins, domestic dissensions, reverses of fortune, 
privations ; and the presence of the parents and friends of the patient, exas- 
perates the evil. Sometimes, an excess of tenderness keeps up the disease. 

A husband persuades himself that he cannot secure the happiness of his 
wife ; and resolves to fly from her, or to terminate his existence, as the only 
means by which he can render her happy. The tears of his wife, and her sad 
countenance, are only new motives for inducing him to commit the act. 

Has the first commotion amid the intellectual and moral faculties, originated 
in the house of the insane man, and in the midst of his neighbors ? The 
sight of this house and his acquaintances, will constantly revive in the mind 
of the insane person, his peculiar ideas and sensations. The only means by 
which we can break up this fatal association, must consist in preventing a re- 
newal of the impression ; and, in order to effect this, the patient must be re- 
moved from the causes that produce it. 

We would remark generally, that the insane conceive a dislike and aversion 
to certain individuals,'w'ithout any motive, and nothing induces them to change 
their views. The object of their hatred is usually the person who, before 
their illness, enjoyed their love. It is this circumstance, which renders this 
class of persons so indifferent, and sometimes so dangerous to their friends ; 
whilst strangers are agreeable to them, and suspend their delirium ; either be- 
cause noveky with respect to persons and things is always useful, or because 
they have no recollection, no painful back thought, to attach to the person of 
a stranger ; or because, through a secret sentiment of self-love, they wish to 

conceal their condition. 

I have seen patients appear very calm before their physician and strangers, 
at the same time that they would abuse in a low voice, their relatives or 
friends ; and conceal themselves, in order to pinch, prick, or scratch them. 
Such are the obstacles and inconveniences, which present themselves in view 
of the sojourn of the insane in their families, when we desire to subject them 
to medical treatment. Let us now look at the advantages which patients will 
derive, from treatment in an establishment especially devoted to their use ; 
where' placed in circumstances quite unusual, and committed to the care of 
strancrers, they will receive new impressions. 

Where shall we isolate the patient 1 We have already said that the insane 
man should be placed in an institution devoted to the treatment of mental 
diseases. We prefer a house of this kind to a private one, where our object 
is effected at great expense. Partial isolation rarely succeeds. It presents 
many inconveniences, which we would wish to shun, by withdrawing the in- 
sane from their accustomed places of abode ; and offers very few of the ad- 
vantages of a house in which many patients are assembled. -jc 

The strongest objection that can be urged against establishments devoted 
to this kind of treatment, is founded upon the frightful effects that may result 
from mingling with companions in misfortune. I reply, that, generally, it does 
not injure them,— that it is not an obstacle to a cure— that it is a valuable 
means of treatment, because it obliges the insane to reflect upon their condi- 
tion, because that, common objects no longer making an impression upon their 
minds, they are diverted from themselves, by the extravagances of their com- 
panions. They are obliged to live, out of themselves, and to occupy their 



76 INSANITY. 

thoughts with what is going on around them, — to forget themselves, as it were, 
which is, in itself, a means of cure. The desire of being free, and the need 
of seeing parents and friends, grow out of the privation of these privileges, 
and replace imaginary and unreasonable wants and desires. 

Ennui exercises, in its way, a favorable influence upon the ideas and affec- 
tions of the insane. The presence and conduct of their companions, serves 
as a text to the physician, who wishes to address himself to the imagination. 
However, there are cases in which isolation, like all other remedies, even the 
most useful, may prove injurious ; when it is not modified by the susceptibility 
of the insane, and the character of the delirium ; and with a reference also, 
to their passions, habits, and mode of life. We should never be absolute in 
practice. Art consists, in happily distinguishing the indications which ought 
to lead to a modification of principles, however great the efficacy that expe- 
rience may attribute to them. 

In an Establishment devoted to the treatment of the insane, the arrano-e- 
ments are better adapted to their wants than in a private house. With less 
suffering to the patient, he is more faithfully attended to. What can be done 
with a furious patient in an apartment of a private house, however large ? A 
suitable regard for his security, will render it necessary that he should be 
bound, and confined to his bed ; a painful condition, which augments the de- 
lirium and fury ; while, in a suitable house, he could be indulged in his pro- 
pensities, with less danger to himself and his attendants. In a house of this 
kind, his wants are better understood, and the domestics better instructed. 
The distribution of buildings permit the patients to be removed, from one 
habitation to another, as his condition, his disposition to injure himself, or his 
progress towards recovery may render expedient. These truths, useful in the 
management of the rich who are insane, are of rigorous application in the 
treatment of the poor. 

An Establishment for the insane must be governed by regulations, to which 
all must submit. This will serve as a response to all objections, and aid in 
surmounting all repugnance, at the same time that it furnishes motives to obe- 
dience, less unpleasant, than the will or caprice of a principal. 

There is, in a house of this kind, a movement, an activity, a vortex, into 
which by degrees, all enter. The most infatuated and jealous lypemaniac 
finds himself, almost without knowing it, forced to live out of himself; car- 
ried along by the general movement, by the example, and by the impressions, 
ofi;en strange, which are perpetually striking his senses. The maniac himself, 
attracted by the harmony, order and regularity of the house, defends himself 
better against his impulses, and abandons himself less to his eccentric actions. 

In an Establishment for the insane, there must be a Head, and a single 
Head, from whom all authority should emanate. Reil, and those who, after 
him, have desired that a hospital for the insane should be directed by a physi- 
cian, a psychologist and moralist, had no practical experience, and did not ap- 
preciate the inconveniences attending a division of powers. When there are 
several coordinate powers, and the mind of the insane knows not upon whom 
to repose, it wanders in doubt ; confidence is not established. Now, without 
confidence, there is no cure. A spirit of independence evades obedience, 
when authority is divided. It is to prevent this double inconvenience, that we 
admit with caution, of interviews between the insane and their friends. The 
insane are but grown up children, children too, who have received false no- 
tions, and a wrong direction. So many points of resemblance do they bear 
to children and young persons, that it will not be surprising, if both one and 
the other should be governed on similar principles. 

The physician who, in an establishment of this kind, gives an impulse to 
every thing ; to whom is referred whatever interests each individual ; — sees his 
patients more frequently than he would otherwise do, — is more frequently in- 



INSANITY. 77 

formed of whatever affects them, — interferes in their dissensions and quarrels, 
— governs them by principles more clear and positive, — controls their actions, 
and causes them to be attended by people who are accustomed to the care of 
the insane. Attendants should set an example of deference and obedience to 
the regulations, and head of the house. By their numbers, they present an 
array of force, which renders its employment unnecessary ; they persuade 
those most excited, that all resistance would be vain ; in fine, living among 
the sick, the latter are not alone, nor always surrounded by irrational persons. 
Example, which exerts such power over the determinations of man, has also 
great influence with the insane. We must not forget what has been said re- 
specting the sagacity of the insane, in comprehending what is passing around 
them. The restoration and discharge of a patient inspires confidence in the 
hearts of others. It establishes in their minds the hope of a cure, and the 
certainty of being set at liberty. The convalescent, by their contentment, 
their advice and counsels, console and encourage the sick, and are, in this 
way, of great service to them. Thus, the inmates of a house of this kind, 
produce a happy influence, one upon another, and every thing concurs to fa- 
vor the success of treatment. The arrangements also, are such that the sick 
can neither injure themselves nor their companions ni misfortune, nor triose 
who serve them. 

The quietude which the insane enjoy, far from tumult and noise ; the mora 
repose which their withdrawal from their former habits, their business, and 
domestic cares procure, are very favorable to their restoration. Subjected to 
a regular life, to discipline, and a well ordered regimen, they are constrained 
to rertect upon the change in their situation. The necessity of restraining 
and composing themselves with strangers, and the dwelling together with com- 
panions in misfortune, are powerful auxiliaries in restoring their lost reason. 

The attentions which an insane person receives in his family, pass for no- 
thing, though all around him be eager in offering them. But away from home, 
the care that is bestowed upon him is appreciated, because it is new, and is 
not strictly due. Civilities, attentions and mildness, will produce an effect, 
because he has little right to expect them at the hands of those with whom 
he is not acquainted. Let a man, practiced and skillful, profit by this dispo- 
sition ; let him command confidence and esteem, and the insane will shortly 
find in the unknown, a person whom they must control, or to whose kindness 
submit. The necessity of a dependence from which they cannot escape, hope, 
fear, ennui even, will begin to make them suspicious that they are sick. Hav- 
ing acquired this conviction, the cure is not far distant. 

Sometimes the insane, when placed in a new situation, think themselves 
abandoned by their relatives and friends. But let those to whom they are 
brought, be prodigal of consolations and regards, let them promise to assist 
in renewing the connection which binds these unhappy people to moral ex- 
istence, and they pass from a state of despair to that of hope. This contrast 
of sentiments, springing from their presumed abandonment, and the tender 
cares and sympathy bestowed upon them by strangers, provoke an internal 
struggle, from which reason sometimes comes off victorious. Others imagine 
that they have been brought to this new abode, only to be given up to their 
enemies or to punishment. If these fears are overcome by civil and affable 
conduct, on the part of those by whom they are surrounded, a cure will soon 
be effected. 

Thus, reason comes to the support of experience, to strengthen the doctrine 
of isolation, as a preliminary condition to all rational treatment of mental 
alienation. 

But, says an objector, it may happen, that by dwelling together, the insane 
may injure each other. The soundest mind would be disturbed, were its ha- 
bits abruptly changed, and brought into contact only with the insane. Be- 




/ 



78 INSANITY. 

sides, after a cure has been effected, how can we conceal from the patient the 
condition in which he has been ? Why tear away from the seat of all his affec- 
tions, a miserable man, whom misfortunes have overcome? Why shut up a 
man who, above all things, dreads a prison. — But, how many objections have 
already been made ? How many may not still be offered ? These objections 
however, do not do away with the inconveniences and advantages that we 
have pointed out above, and to which experience returns a favoring response. 

But, it may be said, that there are insane persons who are cured at home. 
This is true. These cures however, are rare, and cannot impair the general 
rule. They prove only, that isolation, like all other curative means, ought 
always to be prescribed by a physician. I will say more, — that isolation has 
been fatal to some insane persons. And what shall we conclude from this 1 
That we should recommend it with caution ; especially when it is to be pro- 
longed ; and also, that it is the nature of the best and most useful things, not 
to be always exempt from inconveniences. To the wise, judicious and ex- 
perienced physician does it belong, to foresee and prevent them. 

It is not easy to determine the period at which isolation should cease. To 
prevent abuse, extreme caution and tact are requisite. Here, experience is 
slow to decide. I recommend nothing positive with respect to it, except that 
when isolation has had no effect, the visits of relatives and friends .should be 
encouraged, exercising much discretion in the choice of the first persons who 
may be admitted. Visits, in the.se cases, should be sudden and unexpected, 
in order to produce a strong impression upon the patient. With respect to 
convalescents, visits are to be allowed with great caution. Experience shows, 
that isolation unduly prolonged, is attended with consequences less injurious 
than its premature cessation. 

We should ever bear in mind, that at the commencement of insanity, this 
affection strongly resembles febrile delirium — that a mistake is easily made, 
and that unseasonable isolation may compromise the cure of the patient, and 
the moral responsibility of the physician. In doubtful and difficult cases, we 
should delay a few days, in order that the characteristics of mental alienation 
may become evident. 

In dementia and idiocy, isolation is only indicated, to prevent accidents which 
may be grave, and to maintain order and security. Some lypemaniacs are 
injured by confinement, in consequence of their excessive sensibility. Mono- 
maniacs and maniacs must of necessity be isolated. Confinement is indis- 
pensable for the insane poor, because they are deprived of necessary attentions 
at home, and can, in a thousand ways, compromise their own, and the exist- 
ence of their friends. 

Isolation is not always effected in the same manner. It is partial, when the 
patient remains at home, and is only separated from the members of his fa- 
mily, and persons with whom he has habitually lived. We isolate an insane 
man, by causing him to travel with his near connections, friends, or strangers. 
We isolate him, by placing him alone in a habitation unknown to him, as well 
as those who serve him. In fine, he is isolated in a public or private estab- 
lishment, devoted to the reception of many people, affected with mental alien- 
ation. 

■ Isolation acts directly upon the brain, and forces this organ to repose, by 
■ withdrawing the insane man from irritating impressions, — by repressing the 
/ vivacity and mobility of impressions, — by moderating the exaltation of the 
' ideas and affections. By reducing the maniac to the smallest possible num- 
ber of sensations, we are enabled to fix his attention, by unexpected and oft- 
re'peated impressions. We must, on the contrary, use strong measures with 
the monomaniac and lypemaniac, to draw them away from their concentrated 
ideas, and force them to direct their attention upon objects, foreign to their 
meditations, disquietudes, and delirious pretensions. We must excite the 



INSANITY. 79 

enfeebled attention of him who is in a state of dementia ; but the happy ef- 
fects which we may propose to ourselves are obtained only by means of 
strong mental impressions, unexpected events, lively, animated, and brief 
conversations ; for it is not by long arguments that we are to expect to be- 
jiefit the insane. We should ever speak with truth and sincerity to the in- 
sane, and only employ the language of reason and kindness. To expect how-1 
ever, to cure the insane by syllogisms and reasoning, indicates little know- 
ledge of the clinical history of mental alienation. " 1 understand you per- 
fectly " said a young lypemaniac, " and if I were convinced, I should be 
cured." Said another, ^'' I knoin what I ought to do, I would do it ; hut give 
me the pmoer, the ability rchich is wanting, and you will have cured me." 

It is here that we must employ a perturbing mode of treatment ; — breaking 
up one spasm by another, by provoking moral shocks, which may dissipate the 
clouds which obscure the reason, — rend the veil which interposes between 
man and the external world, — break the vicious chain of ideas, — bring to an 
end injurious associations, — destroy their despairing concentration of thought, 
and break the chain which paralyzes all the active powers of the insane. We 
effect this object by arousing the attention of the insane, now by presenting 
to them new objects, now by causing them to witness new and surprising phe- 
nomena ; now, by putting them in opposition to themselves ; and sometimes, 
by taking up their ideas, caressing and flattering them. By complying with 
their desires, we secure their confidence, — a sure test of an approaching cure. 
We must bring into subjection the whole character of some patients, con(iuer 
their pretensions, control their freaks of passion, break down their pride ; 
while we must arouse and encourage others. 

We repress the passionate transports of the maniac, and sustain the broken 
spirit of the lypemaniac. We oppose the passions of the one to those of the 
other, and from this struorgle, reason sometimes comes off victorious. Fear is 
a depressing passion, which exercises such an influence over the economy, as 
to suspend, and even extinguish vital actions. 

Can we hope to cure those whom fear pursues and devours, if we do not 
inspire them with confidence ? Many insane persons sleep not ; aroused by 
panic terrors. Encourage them, by causing some one to sleep in their cham- 
ber, or by allowing them a light during the night. It is above all, important 
to substitute a real for an imaginary passion. This monomaniac becomes 
dissatisfied, although using every thing with an unsparing hand. Cut him off 
from this habit, and impose upon him real privations ; then will satiety, found- 
ed on reason, prove a powerful means of cure. A lypemaniac believes that 
he is abandoned by his friends. Deprive him of those proofs of affection 
which he forgets ; then will he regret their loss, and desire them ; and this 
natural uneasiness, these reasonable desires, will prove a means of cure. 

To combat the self-love and vanity of some insane persons, certain allusions 
may be made to the superiority of others, and to the embarrassments of their 
own position. Sometimes displeasure opportunely manifested, has been use- 
ful. Great experience however, is necessary, to control these passions. The 
exciting passions of love and ambition, have been called in, to aid in the 
treatment of the insane. A melancholic is in despair. A law suit is suppos- 
ed to be instituted against him. The desire to defend his interests restores 
his intellectual energy. A soldier becomes a maniac. After some months, 
he is told that a campaign is about to commence. He demands permission 
to rejoin his general, returns to the army, and arrives there in good health. 

Pinel oflfers some remarkable observations, on the art of directing the intel- 
ligence and passions of the insane. 

I have published several in my dissertation on the passions, and proved by 
facts, how valuable is moral treatment, whether we desire to prevent the out- 
break of an attack of insanity, or are called to treat the malady, or propose 




80 INSANITY. 

to confirm a convalescence. This treatment besides, is not confined exclu- 
sively to mental maladies : it is applicable to all others. It is not enough to 
say to the sick, courage, courage, you tcill be better. A feeling heart must 
dictate these consoling words, that they may reach the mind and heart of him 
who suffers. How happens it, that in an age in which we have so triumph- 
antly established the influence of the moral over the physical man, that the.se 
researches upon man in a state of disease, have not been extended ? Gaubi- 
us complains of the negligence of physicians in this respect. 

The ancients attached great importance to moral therapeutics, which are 
so much neglected by the moderns. From the highest antiquity, the art of 
healing was committed to the ministers of the altar. There were temples 
celebrated for the cures they had wrought. A long voyage, a new climate, 
the salubrity of holy places, the change of habits and modes of life, purifica- 
tions, processional marches, the use of thermal waters, and diet, prepared the 
way for the moral influence which their ceremonies and mysterious practices 
were to produce upon the sick. The Egyptians, Greeks and Romans, had 
their ^sculapii, whose priests preserved a medical liturgy, and to whom they 
were accustomed to come, seeking health. The moderns made their pilgrim- 
ages to the revered remains of some saint. In some cities, festivals were cele- 
brated, to which were conducted with pomp, both epileptics and the insane, 
who were sometimes cured.* In our day we have found a great physician. 
His name, his consolations, his councils, are often more useful than his reme- 
dies, because his reputation commands confidence, and permits us not to doubt 
respecting a cure. 

The means and resources proper for the moral treatment, and the opportu- 
nity for its employment, are indicated by circumstances. Examples of its 
employment are found in all books. I have published many of them, which 
may be found in the different essays of which this collection is composed. 

The ancients have boasted of the wonderful effects of music. Herodotus 
and Pausanias assure us, that most legislators were musicians, — that music 
was employed to civilize men. The phrygian measure excited to fury, — the 
lydian, soothed to melancholy — the eolian was devoted to the amorous pas- 
sions. Each passion had a rhythm which was proper to it ; while the moderns 
have sacrificed every thing to harmony. The Jews, Greeks, and Romans 
were all equally aware of the power of music. 

Every body knows the effect which the " ranz des vaches" produced upon 
the Swiss. Music acts upon the physical system, by producing gentle shocks 
upon the nerves, by quickening the circulation, as Gretiy observed in his own 
person. It acts upon our moral nature, or the mind, in fixing the attention 
by mild impressions, and in exciting the imagination and even the passions, 
by agreeable recollections. Did they wish success in the treatment of the in- 
sane, they would make choice of a small number of instruments, — place the 
musicians out of sight of the patient, and execute airs familiar to his infancy, 
or which were agreeable to him before his illness. I have often employed 
music, but have rarely been successful with it. It brings peace and compo- 
sure of mind, but does not cure. I have seen those whom music rendered 
furious ; one, because all the tones appeared false ; another, because he 
thought it dreadful that people should amuse themselves near a wretch like 
him. Finally, I believe that the ancients have exaggerated the effects of mu- 
sic, as well as many other things. The facts, reported by the moderns, are 
not sufficiently numerous to enable us to determine the circumstances in 
which music may be useful. However, it is a valuable remedial agent, parti- 
cularly in convalescence. It ought not to be neglected, however indetermi- 
nate may be the principles of its application, or uncertain its efficacy. 

* Lecture II. Note respecting die village of Glieel. 



INSANITY. 81 

The means of diverting the mind are, nevertheless, after labor, the most 
efficacious agents in the cure of the insane, but we cannot rely upon the suc- 
cess of those which exalt the imagination and passions. 

The lypemaniac, always suspicious, appropriates to himself whatever strikes 
his senses, and makes it serve as aliment to his delirium. Tlie maniac be- 
comes still more excited by the representation of the passions, by the vivacity 
of the dialogue, and the playing of the actors, if he is present at a theatrical 
representation. Our opinion respecting amusements of this kind is support- 
ed by the example of the Egyptians and Greeks. But witli them these exhi- 
bitions partook of a religious character, adapted to calm the passions, and to 
impose upon the imagination, at the same time that the mind was diverted by 
the pomp of the ceremonies. A mind at all accustomed to reflection, is asto- 
nished that theatrical representations should formerly have been permitted at 
Charenton ; and a German author regards the multiplication of theatres as 
one of the causes of the great number of insane people in Germany. The 
maniacs could never be present at the theatrical representations of Charenton, 
the monomaniacs rarely, — and imbeciles could not be benefited by them. 
Those to whom the spectacle could be useful, were already cured, and it would 
have been more profitable to restore them to liberty than to shut them up for 
three hours in a place, confined, heated and noisy, where every thing tended 
to produce cephalalgia. Thus there were few representations that were not 
signalized by some violent explosion of delirium, or by some relapse. This 
mode of amusement, by which the public were imposed upon by being inform- 
ed that the insane themselves played comedies, never obtained the approbation 
of the Physician in chief of the Establishment. Royer-Collard exerted him- 
self vigorously against it, and was ultimately successful in bringing it to an 
end. I once accompanied a young convalescent to a Comic Opera. He 
every where saw his wife conversing with men. Another, after the space of 
a quarter of an hour, felt the heat in his head increasing — and says, let us go 
out, or I shall relapse. A young lady, being at the Opera, and seeing the ac- 
tors armed with sabres, believed that they were going to assail her. All this 
happened, notwithstanding 1 had selected both the individuals I was to accom- 
pany, and the pieces that were to be acted. A theatrical spectacle can never 
be suited to the condition of the insane, and I much fear, not even to that of 
convalescents. 

Seneca says, that traveling is of little benefit in moral aflfections. He cites 
on this subject, the reply of Socrates to a melancholic, who was complaining 
that he had derived little advantage from his travels. "/«m not siirj)ri.sr(l ; 
do you not travel with yourself 7" However, the ancients prescribed traveling, 
and sent their patients to take the hellebore of Antycira, or to make the leap at 
Leucates. The English now send their melancholies into the southern pro- 
vinces of France, into Italy, and even into the colonies. I have always ob- 
served that the insane are relieved by a long voyage, especially if they have 
visited distant countries, whose situation and aspect took strong hold of their 
imagination ; and if they experienced difficulties, opposition, disappointments, 
and the fatigues incident to travel. Traveling acts moreover, by exciting all 
the assimilative functions. It promotes sleep, the appetite and secretions. 
Convalescents, who fear to re-enter the world, where they will be called upon 
to speak of their complaint, are less uneasy, after a journey which may be 
made the subject of conversation with their friends. Such are the agents 
which exercise a direct influence over the brain, and consequently over the 
intellectual and moral disorders of the insane ; and such are the o-eneral views 
of their application, which I would suggest. They have for their object, to 
restrain the mental operations of the maniac, and to draw out and fix upon 
external objects the mind and thoughts of the monomaniac. The prin- 
ciples of physical treatment cannot be reduced to propositions so general. 

11 





82 INSANITY. 

No one doubts the necessity of acting upon the brain, in combating the causes 
which have produced and keep up insanity ; but the nature of tliese causes 
often escapes us. The brain is not always the primitive seat of their action, 
and this, moreover, does not produce the same eifect in every case. The 
physical means, therefore, adapted to avoid the fatal effects of these causes, 
must be varied. They are hygienic, or pharmaceutic. 

The constitution of the insane becomes rapidly enfeebled. They contract 
affections of the skin, lymphatic engorgements and scurvy ; a circumstance 
which shows the importance of a suitable site, as well as mode of construction 
of their habitations. In building a house for the insane, we should select a 
site, in our country, with a southeastern exposure ; with an exposure to the 
west in warm countries ; and to the south, at the north. The soil should be 
dry, and light. The lodging rooms should be protected against humidity 
and cold ; and favorably disposed for ventilation. It is a grave error to sup- 
pose that the insane are insensible to atmospheric influences. The greater 
part of them avoid cold, and desire warmth. 

The ancients recommended that maniacs should be placed in a situation 
cool and obscure. This precept is excellent during the acute period of the 
malady ; but when it has passed into the chronic state, Pinel advises that 
they be left to all the activity of their movements, and in the open air. Situ- 
ations well lighted, cheerful and picturesque, are suited to lypemaniacs. 
Those who have become insane in warm climates, will be more likely to re- 
cover their reason by returning to a cold one ; and reciprocally. Those af- 
flicted with nostalgia will be restored only by returning to their country, the 
places where they were born, and where their infancy was passed. 

The clothing, especially that of the lypemaniac, should be warm. The use 
of woolen garments next the skin, and of dry frictions, will be found of ser- 
vice. The bedding may consist of a matress and hair-quilt, together with a 
bolster and pillow of horse-hair. The patient should repose upon a bed of 
horse-hair. The covering should be light, and the head usually uncovered. 
Alimentation should be varied according to the nature and period of the ma- 
lady, — the individual circumstances and complications. At its commence- 
ment we prescribe the diet to which most patients are subjected during the 
early stage of other acute disorders ; at a later period the quantity and quality 
of aliments are modified. They should always be simple, prepared without 
spices, and easy of digestion. During convalescence, the aliment should be 
more substantial than previously, without ever being excitant, and in some 
very rare cases should be more abundant. The food should be distributed 
with discretion. We should avoid furnishing at once a day's supply, as is 
done in some hospitals. It results, from a neglect of this precaution, that the 
patients devour or destroy a day's provision at once ; and, tormented by hun- 
ger during the remainder of it, they become more furious or sorrowful, sup- 
posing that they are maliciously refused a supply of their wants, or that the 
design of starving them to death, is entertained by those who have the charge 
of them. The greater part of maniacs and monomaniacs are distressed by 
thirst. We must satisfy this desire by placing appropriate drinks at their 
doors, or by distributing them at certain hours during the day. 

Those aliments and drinks which excite the patient, should be proscribed 
during every period of the malady. Nevertheless, they may be adapted to 
some cases of dementia, or monomania, and to the period of convalescence, 
as I have just remarked. Both the secretions and excretions should be favor- 
ed in every possible manner. We should watch with care, the condition of 
the bowels ; for constipation is a frequent symptom, and one which exaspe- 
rates the delirium. 

Corporeal exercises, riding on horseback, the game of tennis, fencing, swim- 
ming and traveling, especially in melancholy, should be employed, in aid of 

V 



INSANITY. S3 

other means of treatment. The culture of the earth, with a certain class of 
the insane, may be advantageously substituted for all other exercises. We 
know the result to which a Scotch farmer arrived, by the use of labor. He 
rendered himself celebrated by the cure of certain insane persons, whom he 
obliged to labor in his fields. 

Bourgoin, in his Travels in Spain, remarks, that the rich at the Hospitrd for , - 
the insane at Saragossa, are not restored, because they are not obliged to labor ; j " 
whilst the poor work and are cured. Pinel recommends that an Establishment 
for the insane should have a farm connected with it, on which the patients \ 
can labor. The cultivation of the garden has succeeded happily in the cure \ 
of some insane persons. At the Salpetriere, the best results follow the inari 
nual labor of the women in that Hospital. They are assembled in a large 
working room, w-here some engage in sewing or knitting ; while others per- 
form the service of the house, and cultivate the garden. This precious re- 
source is wanting in the treatment of the rich of either sex. An imperfect 
substitute is furnished, in walks, nmsic, reading, assemblages, etc. The ha- 
bit of idleness among the wealthy, counterbalances all the other advantages 
which this class enjoy for obtaining a cure. 

To establish the basis of a certain therapeutic treatment of mental aliena- 
tion, it would be necessary to understand all the general and individual causes 
of tins malady ; to distinguish by certain signs, the source from whence all 
disorders spring ; to determine whether the physical reacts upon the moral, or 
the moral upon the physical ; to establish the varieties of insanity that are 
cured .spontaneously ; those which call for moral aids ; those which require 
medication ; and finally, those which yield only to a mixed treatment. What 
accidents have bef<dlen, wlxat obstacles opposed those physicians, who have 
been unwilling to see but one disorder, in all the forms of insanity that 
they have been called to treat ! They inferred that delirium being symp- 
tomatic of almost all maladies at the approach of their fatal termination, in- 
sanity might also be symptomatic. They were not ignorant that there were 
forms of insanity evidently sympathetic : they knew that a thousand predispos- 
ing and exciting causes lead to insanity ; but having regard only to the most 
apparent symptoms, they have permitted themselves to be diverted by the im- 
petuosity, violence, and changefulness of the symptoms, and neglected the 
study of the causes of insanity, and the relations which they bear to the symp- 
toms. Drawn away by theories, some have seen nothing but inflannnation ; 
have charged upon the blood the production of insanity, and employed bleed- 
inor to excess. Others believed that the bile was the source of irritation, and 
that it restrained and interfered with the due performance of organic func- 
tions. They were prodigal of emetics and drastic purgatives. Others still 
have taken account only of tlie nervous influence, and employed antispasmo- 
dics in excess. All have forgotten, that if the practitioner ought always to 
have before his mind great generid truths, — systematic views, which are to 
predominate, and which constitute medical science ; art should confine itself 
to the most careful study of the circumstances and symptoms, which will best ■ 
acquaint us with the causes and seat ; in a word, with the nature of the mala- 
dy which we are to combat. 

When called to visit an insane person, after having acquired a knowledge 
of his history, together with the predisposing and exciting causes of his at- 
tack, we should inquire if there are no urgent indications to fulfil. To ascer- 
tain the cause of the malady, will, in general, furnish a clue to the best mode 
of treatment. To recall the menses when suppressed, to reestablish old ul- 
cers, to provoke cutaneous affections, and to insert issues, if the patient had 
formerly been accustomed to them, will be peculiarly proper. If there is 
active excitement attended with plethora, these symptoms must be controlled 
by sanguine evacuations, tepid baths and emollients long continued ; together 
with cooling and laxative drinks. Sometimes it will be necessary to apply to 



84 



1 1\ S A N I T Y . 



/ 



\ 



the skin rubefacient derivatives. At the same time, the strictest attention 
should be paid to the diet and regimen of the patient. Treated as an acute 
disorder, almost always at the expiration of 8, 15, 21, or 30 days, there is a 
remission, and sometimes a very marked intermission. Then, in connection 
with those moral means appropriate to the character of the delirium, we must 
set ourselves to combating those material causes, whether hygienic or patho- 
logical, which had preceded and induced the malady ; in every case, following 
the individual indications. Let it suffice, to point out a few of these indica- 
tions. A man becomes insane, who has been subject to hemorrhages which 
no longer exist. The physician succeeds in establishing this evacuation, and 
at the same time in restoring reason to his patient. A cutaneous affection 
disappears ; an ulcer dries up, and mania or monomania bursts forth. On re- 
calling the disorder of the skin, and reopening the ulcer, it is almost certain 
that the insanity will cease. 

When we have attacked and overcome the general derangements, the pain- 
ful effects of particular causes, if the insanity is not cured, we may have re- 
course to an empirical treatment. We may here vary without ceasing, those 
measures which experience suggests. We shall point them out, when speak- 
ing of the different forms of insanity. We shall content ourselves for the 
present, by stating our opinion respecting the mode of action of certain reme- 
dies denominated heroic, in the treatment of this disease. 

Water by all methods, and at every temperature, has been administered to 
the insane. Tepid baths, from 20'^ to 25° Reaumur, are the most useful. We 
may even prolong their use for several hours in succession, among lean, ner- 
vous and very irritable subjects. When there is a strong determination of 
blood to the head, we find it advantageous to apply bladders filled with very 
cold water, or cloths saturated with the same to the head, during the continu- 
ance of the bath. The cold bath is adapted to young, strong, and robust 
subjects, who are devoured by heat. The cold acts by removing to some 
extent, the excess of heat, or by exciting the tonic action of the skin. Some 
authors have advised hot baths. Prosper Alpin advises them ; perhaps we 
neglect them too much. The baths are rendered more active by mingling 
with the water divers kinds of substances, more or less medicinal. 

The bath of immersion consists in plunging the patient into cold water, 
and withdrawing him immediately. This may be repeated three, four, five 
and six times. The bath of affusion, following the method of Currie, is ad- 
ministered by placing the patient in an empty bathing tub, and pouring upon 
his head cold water, whose temperature is reduced at each bath. The baths 
of immersion and affusion are particularly useful to subjects enfeebled by 
masturbation, or by long grief, and in whose cases we wish to produce a re- 
action, by withdrawing from the centre, nervous power, and calling it to the 
circumference. These baths differ from the bath of surprise. The latter con- 
sists in plunging the patient into the water when he least expects it. We ad- 
minister it, by precipitating him into a reservoir, a river, or the sea. It is the 
frio-ht which renders this means efficacious in overcoming sensibility. We 
can conceive the vivid impression that a })atient experiences, who falls unex- 
pectedly into the water, with the fear of being drowned. 

Van Helmont recommends that the patient be kept under the water, till 
loss of consciousness takes place. Van Swieten, commenting upon Boer- 
haave, insists upon this means, which was almost the only one, in connection 
with blood-letting, employed during the last century. However, we have no 
facts illustrating the effects of this practice. Pinel proscribed the bath of 
surprise. I have never made use of it, but am certain that it has been fatal. 
When I hear of its being prescribed, I should prefer rather, that they advised 
to precipitate the patient from the third story, because we have known some 
insane persons cured by falling upon the head. The douche consists in pour- 



INSANITY, 



85 



ing water upon the head from a greater or less height. It was known to the 

ancients ; and is administered in different ways. At Avignon, the tube of the 

douche, with a flute-like termination, is placed about a foot above the head of 

the patient. At Bordeaux, it terminates in a head like that of a watering pot. 

At the Salpetriere, the douches terminate in tubes of four, six and twelve lines 

in diameter, and the water falls from different heights. The water is usually 

at the atmospheric temperature. It has been proposed to employ hot water 

in some cases of dementia. The patient receives the douche, seated in an / 

arm chair ; or better, plunged into a bath of tepid or cold water. I.^^m'XA^ 

The douche produces its effects, both by the action of the cold, and the \ ^ 
percussion. It exercises a sympathetic influence upon the region of the epi- 
gastrium. It causes cardialgia, and desires to vomit. After its action ceases, 
the patients are pale, and sometimes sallow. It acts also morally, as a means 
of repression ; a douche often sufficing to calm a raging excitement, to break 
up dangerous resolutions, or force a patient to obedience. It is that class of 
the insane who are young, strong and active, who require the douche. They 
experience after having received it, a sensation of coolness about the head, 
which is very agreeable to them, and often very useful. It is especially pro- 
per in cases attended with cephalagia. The douche ought to be employed 
with discretion, and never immediately after a repast. It is necessary to ob- 
viate constipation before employing it. Its employment ought to be continued 
but a few minutes at a time, and its administration never to be left to servants. 
They may abuse it, and we ought not to be ignorant that the douche is not 
exempt from grave accidents. Ice has been applied to the head. Its long 
continued application calms the cephalagia and fury which resists blood-let- 
ting, general baths, and the douche, especially at the commencement of ma- 
nia"; when there is redness and heat of face, threatening cerebral congestion. 
This application succeeds much better when the feet of the patient are 
plunged into very warm water, or enveloped in an irritating cataplasm. 

Revulsive pediluvia, produce a remote irritation, which is often salutary. 
We render them irritant, by the elevated temperature of the water, by the ad- 
dition of the muriates of soda, ammonia, and powdered mustard. We ought 
to remember, that if the water is too warm at first, it causes pain, which re- 
acts upon the brain. By plunging the legs into an emollient decoction, slight- 
ly warmed, and allowing them to remain there for a considerable period, we 
relieve the patient of cramps. We moreover make use of water by jets, fre- 
quently repeated ; throwing it upon the faces of some, who are laboring under 
a stupor. These slight excitements, frequent and unexpected, have sometimes 
aroused patients from their lethargy. Water has been prescribed by injec- 
tions ; sometimes pure, sometimes combined with purgative, and soothing or 
antispasmodic remedies, as the indications required. The douche by the rec- 
tum has also been advised, to overcome obstinate constipation, — to unload 
the large intestines, and to relieve the spasm of the alimentary canal ; some- I -' 

times to give tone to this tract, or to provoke a derivative irritation. , rHA-^ 

Avenbrugger recommended the internal use of cold water, drank in large [/b • — 
quantities, at the rate of a tumbler every hour. Hufeland regards this means akA^ 
as of service in mania. Leroi d'Anvers has published an account of the y-'^-''^'^ (^ ^ 
advantages of cold water, as a preventive of suicide. Many facts seem to ^i^^- 
justify this practice. The most interesting is that of Theden, a very distin-' 
guished Prussian surgeon, who having been hypochondriacal in his youth, at 
length became melancholic, with a disposition to commit suicide. The copi- 
ous use of cold water restored him to health. He drank of it from twenty- 
four to thirty pints a day. From a favorable opinion of its utility, as well as 
from the force of habit, Theden has reported, that at the age of eighty years, 
he drank every day, several pints of cold water. Hufeland confirms this 



v/ 



86 INSANITY. 

fact by two cases which he has collected. This means has been particularly 
advised, as a preventive of suicide. 

Evacuants have been celebrated from the highest antiquity, and for a long 
time formed the basis of treatment in insanity, particularly lypemania. Far 
from being adapted to all cases, they may augment the evil. The moderns 
have advised emetics, which ought to hold a high place in the treatment of 
some forms of monomania, and lypemania with stupor. Emetics are suited 
to those cases in which the sensibility is blunted, where the patient seems 
stricken with atony, whilst they would be injurious, did irritation exist. Ma- 
son Cox places emetics in the front rank of remedies, in every stage of in- 
sanity. Rush believes emetics most useful in hypochondriacal melancholy. 
They repeat them many days in succession. Besides the sensible evacuations 
which they provoke, they excite the transpiration, and cause succussions use- 
ful in relieving spasms of the abdominal viscera. Purgatives are also praised. 
The choice of purgatives is not a matter of indifference. In some cases, we 
prefer those which have a special action upon the hepatic system, the hemor- 
rhoidal vessels, upon intestinal worms, etc. ' Purgatives often cause irritation, 
thereby suspending the activity of the skhi. To prevent these accidents, or 
consecutive effects, we alternate them with the tepid bath. Many insane per- 
sons think themselves very well, and refuse all medication. We may triumph 
over this repugnance by causing them to take without their knowledge, some 
substance which, by irritating the stomach or intestines, provokes pains, and 
even evacuations. These accidents, by causing uneasiness in the mind of 
the patient respecting his health, render him docile. Hellebore, gamboge, 
bryony, aloes, submuriate of mercury, and especially the tartrate of antimony 
and potassa, together with purgative mineral waters, are the therapeutic 
agents, which we may at such times employ with advantage. 

M. Chrestien, a celebrated practitioner of Montpellier, proposes colocynth, 
administered by friction upon the abdomen, as a sure purgative. He goes so 
far as to recommend this substance as a specific in insanity. I have repeated 
the experiments of M. Chrestien, upon twenty insane persons, but have not 
been equally successful with himself. The colocynth not only failed to effect 
a cure, but did not purge, except in two instances after confinement. 

On the discovery of the circulation of the blood, it was believed that we 
had discovered the cause of every disorder, and a remedy for all ills. Blood 
was shed abundantly. The blood of the insane was the more freely shed, as 
by bleeding them to faintness, it was believed that they were cured. This 
treatment was extended to all the insane. In every hospital, there was estab- 
lished what was called, the treatment of the insane on this principle; that the 
blood being too abundant and too much heated, ouorht to be evacuated and 
cooled. Besides, in the hospitals of France, where some attention was paid 
to the insane, in spring and autumn, they bled them once or twice, and bathed 
them in cold water ; or cast them, bound hand and foot, into a river or reser- 
voir. If a {e\v victims of such gross mismanagement escaped, they cried out, 
a miracle ! Such was the prejudice not long since even at Paris, in favor of 
bleeding, that we were accustomed to receive pregnant women, who were bled 
by way of precaution, before being sent to a house where bleeding was pro- 
scribed. Excess in this respect has sometimes been so great, that I have had 
in charge an insane man, who had been bled thirteen times in forty-eight 
hours. Pinel set himself against this abuse, and cites examples which ought 
to be presented to the observation of all physicians. I can add, that I have 
many times seen insanity increase after abundant menstrual flows, after hemor- 
rhages, and after one, two and even three bleedings. I have seen a state of 
sadness pass into mania and fury, immediately after bleeding ; and dementia 
to replace, reciprocally, the condition of mania. I do not believe it necessary 



J ^ 






INSANITY. 87 

to proscribe blood-letting in the treatment of insanity. It is indispensable in 
plethoric subjects, when the head is strongly congested, and hemorrhages, or 
habitual sanguine evacuations have been suppressed. At the commencement 
of insanity, if there is plethora, if the blood rushes violently to the head, if 
some habitual hemorrhage is suppressed, we bleed largely, once, twice, or 
thrice ; apply leeches to the jugular veins and temporal arteries, and 
cups to the base of the brain. At a later period, sanguine evacuations are 
local, and employed as revulsives, or as supplementary to suppressed evacua- 
tions, etc. The use of energetic tonics and antispasmodics, ought also to be , 
appreciated. Camphor, musk, iron, quinine and antimony, have been employ- '' 
ed in very large doses, as specifics in insanity. These medicines are useful, 
but of individual utility. They succeed surprisingly well, when one is suffi- 
ciently happy to seize the proper indication for their use, which the disease 
presents ; but are hurtful and dangerous if employed indiscriminately. i 

Some insane persons sleep little; passing weeks and months without repose. ., ' 

Narcotics are employed to produce sleep. These medicines are rather hurt- ")/V*^ 
ful than salutary, especially when there is plethora, or congestion of the head. 
For a long time, Valsalva and Morgagni proscribed opiates, and daily prac- » 

lice confirms the judgment of these great masters. Regimen, labor and ex- A },Kk/ 
ercise, are the true remedies for insomnia. Tepid or cool baths provoke { r^ 
sleep, are truly efficacious, and are in no way dangerous. Setons, moxas, the 
actual cautery, cups, vesicatories, irritating and mercurial frictions have been .. 

employed. These means are excellent auxiliaries to provoke a revulsion, to - ' 

bring back a cutaneous eruption which has been suppressed, to arouse the 
sensibility of the skin, which is often in a state of atony, to excite a general 
reaction, etc., etc. It has been proposed to envelope the head with epispas- 
tics, or some other irritating compositions ; and to employ a saturated solution 
of tartrate of antimony and potassa, in water. I must confess, that I have 
never seen those means succeed, which augment irritation, — torment and dis- 
turb the sick, and persuade them that we wish to punish them. It is almost 
always among monomaniacs, or persons in a state of dementia, that we pre- 
scribe a course of medication, so active and perturbating. I do not deny, that 
in some cases, success may have followed this treatment ; but I believe that 
those cases are very rare, and the indications very difficult to appreciate. 

I cannot omit making some remarks respecting the use of fire and moxa, 
applied to the top of the head, and over the occiput or neck in mania. Doc- jp 

tor L. Valentin has published some valuable observations concerning the ^ Jl«J\ 
cure of mania by the application of fire.* I have many times applied the 1*^ r"^ 
iron at a red heat to the neck, in mania complicated with fury, and some- //" 
times with success. I made very many attempts, which always proved fruit- 
less, when I addressed myself to subjects which presented symptoms of para- 
lysis. The seton in the neck, has succeeded better in my hands, except when 
I have applied it to individuals who did not experience the same complica- 
tions, and who were in that stage of dementia which is confounded with 
idiocy. | 

Gmelin and Perfect affirm, that they have effected cures by electricity. At 
the Salpetriere, during two summers, those of 1823 and 1824, I submitted to ^ 
the influence of electricity a large number of our insane women. One only - 
was cured, in the cour.se of my experiments. This was a young and very 
strong girl, who had become a maniac in consequence of a fright, which 
suppressed her menses. She had been insane for a month, and was electrized 
for fifteen days. At the menstrual period, the discharge appeared, and she 

* An Essay and Observations concerning the good effects of the actual cautery, apphed 
to the head in various disorders. Nancy, 1815, in 8vo. 




88 INSANITY. 

was immediately restored. Wennolt tried galvanism. I also employed it, in 
connection with Professor Aldini, in 1812. Twice the menses were restored, 
but the delirium persisted. Experiments have been made with magnetism, 
particularly in Germany. The facts reported in France, in relation to it, are 
neither exact, nor well observed. In 1813 and 1816, I made experiments 
with the late M. Faria, upon eleven insane women, maniacs or monomaniacs. 
One only, who was remarkably hysterical, yielded to the "magnetic influence ; 
but her delirium underwent no change. Magnetism produced no effect upon 
ten other insane persons. These experiments were made in presence of M. 
Desportes, governor of the hospitals, and others, besides several physicians. I 
repeated the same trials, several times, with divers magnetizers, with no better 
success.* 

I ought to say a word respecting the machine of Darwin. This instrument 
which, nearly enough, resembles a circular swing, has passed from the arts, 
to be employed in medicine. Mason Cox made much use of it. Hufeland 
and Horn employed it at Berlin. One of them remains at Geneva, which 
furnished Odier an opportunity to observe its eflects. Poctor Martin, physi- 
cian of the hospital at Antiquaille, where to this day the insane of Lyons are 
treated, has informed me that he had been frightened at the accidents which 
the insane had met with, who had been submitted to the influence of this ma- 
chine. They fell into a state of syncope, and had also copious evacuations 
both by vomiting and purging, which prostrated them extremely. This mode 
of treatment, employed with prudence, may be useful to such insane persons 
as refuse all kinds of medicine, and who present symptoms of gastric de- 
rangement. + 

We should not complete all that relates to the treatment of insanity, did 
(V we neglect to speak of the modes of preventing it. Prophylactic mea- 
\^' sures have for their object the preventing of the disorder, or the return of an 
|n1 attack. These measures are either general or particular. They have been 
already indicated, by an exposition of the causes of insanity. We should 
avoid marriages with persons descended from insane parents. The education 
of man begins in infancy, and we should guard against the recital of such 
stories and fables to children, as disturb the brain, or painfully excite the 
imaorination. While cultivating the mind, we should at the same time form 
the heart, and never lose sight of the fact that education consists less in 
what we learn, than in correct habits of mind, feeling and action. If 
education is neither religious nor moral ; if the child meets with no opposition 
to his wishes or caprices ; if every one yields to his desire ; how will he fami- 
liarize himself to the difticulties with which life abounds 1 We should not 
force the principles of feeling and intelligence, by early fatiguing the brain 
with lessons of inordinate length. We should avoid errors of regimen, which 
often, at the tenderest age, predispose to insanity. We should control, and 
direct the passions of the young. 

The education of those who are born of parents already insane, should be 
less devoted to the cultivation of the mind, than the strengthening of the 
physical powers. The preceptor, informed beforehand of the mental state 
of their parents, and the wanderings of their passions, will educate his pupils 
with reference to this knowledge, — will moderate their undue ardor of mind, 

* Georget has given an account of the experiments in magnetism, which he made at 
the Salpetriere, in a work entitled : " Physiology of the JVervoiis System.'' Paris, 1821, 
tome I. Page 267, and tome II. p. 404. M. Dechambre, who repeated the experiments 
which )ie performed, is convinced that Georget was the dupe of his pretended somnam- 
bulist. See Medical Gazette, year 1835, for a very witty account of the experiments 
made by M. Dechambre 

t Since the first edition of this article was published, the rotary machine has been 
every where abandoned. 



INSANITY. 89 

— check their wayward propensities, and fortify them against the seductive 
influence of the passions ; whilst the physician, aware of the physical causes 
which have provoked the disease in the persons of their parents, will prevent 
the development of these causes, or diminish their deplorable effects, by reori- 
men and medicines adapted to the wants of their children. 

How can we assure ourselves of his convalescence, and prevent relapses, if 
the patient is not submitted during a period, more or less protracted, to a 
mode of life appropriate to his constitution, and to the causes and character 
of the malady from which he has just been restored ? if he avoid not the pre- 
disposing, physical and moral causes, — if he is not watchful against errors of 
regimen, excess of study, and transports of passion 1 Experience has taught 
us that relapses often take place, in consequence of the simultaneous develop- 
ment of physical and moral causes. We must attack with energy, these 
causes, from the moment that they manifest themselves, without awaiting the 
explosion of the delirium. An emetic, and purgatives given in season, may 
arrest an attack of insanity. The application of leeches, and blood-letting, 
in cases of slight menstrual disorder, prevent attacks, which might otherwise 
have taken place. The disappearance of a cutaneous eruption, of the gout, 
or rheumatism, or an habitual evacuation, has preceded a first attack of in- 
sanity. We mu^t be ever watchful of these metastases and suppressions. 
What has been said respecting the precautions which the physical state of 
those who have been insane, demands, is equally true with respect to the 
moral. One man is choleric ; he will relapse unless he exercise all his 
strength to overcome this passion. Another has lost his reason in conse- 
quence of domestic trials. He ought from henceforth to be spared from 
these afflictions. A third remains in imminent danger of a relapse, if he 
does not reform his conduct, and abandon the excesses that have preceded his 
first attack. It is for want of foresight that insanity is so often hereditary ; 
and in consequence of imprudences, that persons who have had one attack of 
insanity are subject to a recurrence of the same malady. 

[In the moral treatment, and general regimen, recommended by our author for the in- 
sane, we heartily concur. It is precisely what at this day is universally admitted and 
employed. His remarks however, with respect to tfte use of tonics, and narcotic and 
sedative agents, are not in accordance with the practice in this country. 

In our Institutions, either singly or in combination, they form in a majority of cases 
requiring it, the basis of treatment, and are indeed of very general application. It is 
proper however to state, that some of the Medical Superintendents of Institutions for 
the insane, whose opinions are entitled to high consideration, while they admit of tonic 
and corroborant treatment in all tho forms of insanity, regard with no little distrust, if 
not with decided disapprobation, the use of narcotics and sedatives. 

The reported results of treatment on the part both of the advocates and opposers of 
these agents, furnish nothing that can with propriety be regarded as decisive on the sub- 
ject ; nor will the latter perhaps admit, that their preferences have been, either by them- 
selves or others, submitted to the test of an extended experience. 

In cases of extreme nervous irritability and excitement, attended with much mental 
agitation, as well as when the mind is weighed down with fearful apprehensions of im- 
pending calamities, or a settled propensity to suicide exists — conditions, both of the body 
and mind which are constantly to be found in Institutions for the insane, — narcotics with 
their soothing influences come in to sustain the exhausted nervous system, and raise the 
sinking spirits, to a degree which, aside from their curative effects, renders their employ- 
ment decidedly advantageous. We have however, in my own opinion, no legitimate 
right to regard any agent which brings even temporary relief to the desponding mind — 

12 



90 INSANITY, 

even though this relief result from an absence of thougnt, rather than from the exercise 
of emotions positively pleasing — as altogether destitute of remedial powers. 

To furnish repose, and to kindle even for a few moments, the flame of hope in a mind 
over which the demon of darkness has long brooded, may, and does oftentimes, bring 
comfort which no language can adequately describe, and encourages the unhappy sufferer 
to make one more effort to escape his dreadful thraldom. His own, in connection with 
the exertions of those to whose enlightened sympathy and care he has been committed, 
often result in ultimate and complete restoration to reason, and sound bodily health. 

In cases attended with a full habit, and considerable arterial reaction, narcotic and se- 
dative agents, when deemed appropriate, are for a time, conjoined with nitre, ipecacu- 
anha, or the antimonials ; and cooling laxatives together with a restricted diet, are prefer- 
red to more direct depletion. 

It is hardly necessary to add, that, while great caution is required in the use of depress- 
ing agents, inflammatory action is in every instance to be promptly met b3' the use of 
active and efficient depletion, both topical and general, commensurate with the severity 
of the case. The most intense nervous excitement however, which is sometimes mis- 
taken for cerebral inflammation, can never require this treatment. It is in view of errors 
of this sort, that the general practitioner is recommended to guard against depletion and 
its too often disastrous consequences. 

Of the medicines employed, the preparations of Iron, (usually the precipitated carbo- 
nate), and the sulphate of Quinine ; Laudanum, the salts of Morphia, Conium, Hyoscy- 
amus. Camphor and Stramonium, are the principal. 

Conium, though largely employed in many Institutions, is at others regarded as inert, 
and therefore laid aside. We state the fact without assigning the reasons for such con- 
tradictory views ; having seen none other offered, than such as grow out of an opposite 
experience in the use of this agent. With respect to Hyoscyamus, Stramonium and 
Camphor, little dependence is placed upon them, though they are sometimes employed. 
Valerian, in some of its forms is considerably used, and Asafoetida, or some .Ethereal 
preparation occasionally. 

Depraved or sluggish secretions, with torpor of the bowels, require the use of alterative 
medicine and laxatives. On no point are the profession more united, than in their op- 
position to prolonged purgation. Iron with Conium is, in many Institutions, very freely 
employed, sometimes in pills, but more generally in a liquid form. 

The following combination has always been a favorite remedy with some, and is large- 
ly employed, with slight modifications, in several Institutions ; 

R 

Carb. Ferri Precipitat. 5xxx 

Ext. Conii 3xv 

Syr. Bals. Tolu. §vi 

Ol. Cinnamom. 

Oi. Limon. aa ^r^xii 

Alcohol §ii 

Aquae Oi 

Spt. Gallici Aut. Vin. Madei. Oss 
Sacchari §iv 

Mix. 

Of this mixture, from half an ounce to an ounce and a half, is to^ be given three 
or four times a day. In every case, it is proper to begin with moderate doses of what- 
ever agent or combination is employed, and increase it gradually, watching its effects. 
So insusceptible are many insane persons to the influence of narcotic and sedative agents, 
that they bear enormous doses of them, not only without injury, but sometimes with the 
most happy results. We have however, no means of ascertaining beforehand, who are, 



INSANITY. 91 

and who are not easily affected by articles of this class. Hence the necessity of cau- 
tion. 

In addition to what has been said in regard to treatment, and the respective merits of 
remedial agents, it is our duty to state distinctly our belief, that not a few of those who 
are presented and received as persons requiring the benefits of an Institution for the in- 
sane, need, for their complete restoration, little else than the moral and restraining in- 
fluences of these Establishments. They have no febrile symptoms to subdue, no special 
degree of prostration requiring support, no marked functional derangement of any organ 
or part to regulate ; in a word, present no indications requiring the use of medicinal 
agents. They are nevertheless insane, and require treatment ; — the peculiar treatment 
just referred to, — without which, the teachings of experience conduct to the inference, 
that they would, in most cases, never recover.] 



X* 



HALLUCINATIONS. 



Definition of, by Esquirol, Sauvages, Sagar, Darwin and other English physicians. — Illus- 
trative cases, with treatment. — Post-mortem examinations. — Farther remarks on hallu- 
cinations. — How accounted for. — Distinction between hallucination, somnambulism, 
and ecstasy. — The convictions of the minds of the hallucinated entire, and their acts 
in accordance with them. — Case of a Jewess ; post-mortem examination of. — Seat of 
hallucinations. — Darwin's and Foville's opinions respecting.- — Subjects to which hallu- 
cinations usually relate. — Very common in insanity. — By some regarded as synony- 
mous with vision. — How it differs therefrom. — Remarks on general treatment. 



b"- 



A PERSON is said to labor under a hallucination, or to be a visionary, who 
has a thorough conviction of the perception of a sensation, when no external 
object, suited to excite this sensation, has impressed the senses. 

Sauvages has given the name of hallucination to those errors which result 
from a lesion of one of the senses ; and when the sensations fail to produce 
that effect upon the mind, which they were accustomed to do before this lesion 
took place. Double vision, imperfect sight, ringing in the ears, are ranked 
by this nosologist in the first order of his division of the insane. But such 
errors and illusions as the other senses and the understanding are capable of 
correcting, should not be confounded with delirium. 

Sagar denominates hallucinations, false perceptions, which form the first 
order of the Vesanise, of his Nosology. Linnaeus places them in the order of 
diseases of the imagination. Cullen ranks them among local maladies. 

Darwin, and after him the English physicians, have given the name of hallu- 
cination to the partial delirium which affects but a single sense; yet the/ 
employ it indifferently, as a synonym with delirium. 

This symptom of delirium has been confounded by all authors with local 
lesions of the senses, with the vicious association of ideas, and in fine, with 
the influence of the imagination. It has been studie d onlywhen it related to 
ideas, which seemed to belong to the sense of sight ; never, when it repro- 
duced those appertaining to other senses. Nevertheless, considered in all its 
varieties, and to whatever sense it may relate, this symptom is very frequent. 
It is one of the elements of insanity, and may be met with in all the forms of 
this malady. The austere writings of every people, the history of magic and 
sorcery in every age, together with the annals of mental medicine, furnish nu- 
merous facts in relation to the subject of hallucinations. I have collected and 
published a great many of them. The following observations will exhibit hal- 
lucinations, as distinct as possible, from other symptoms of insanity. 

M. N., aged 51 years, of a bilious sanguine temperament, having a large 



94 HALLUCINATIONS. 

head, short neck and flushed face, was, in 1812, prefect of a large city of Ger- 
many, the inhabitants of which rose upon the rear-guard of the French army, 
in its retreat. The disorder which resuUed from these events, and the respon- 
sibility which rested upon the prefect, deprived him of the use of his reason. 
He considered himself accused of high treason, and consequently disgraced. 
In this state of mind he cut his throat with a razor. As soon as he had re- 
covered his senses, he hears voices that accuse him. Cured of his wound, 
he hears the same voices, and persuades himself that he is surrounded with 
spies. He believes even that his domestics denounce him. These voices 
are continually repeating in his ear that he has betrayed his trust, — that he is 
dishonored, and that he can do nothing better than destroy himself They 
employ in turn, all the languages of Europe, with which the sick man is con- 
versant. A single one of these voices is understood less distinctly, because it 
borrows the Russian idiom, which M. N. employs with less facility than the 
others. Among these different voices, he hears very clearly that of a lady, 
who calls upon him to take courage, and entertain confidence. He goes aside 
often, the better to hear and understand. He questions and replies, provokes, 
challenges, and becomes angry, while addressing those persons who he be- 
lieves are speaking to him. He is convinced that his enemies, by various 
means, can divine his most secret thoughts, and cause to befall him all the 
evils implied in the threats, reproaches and sinister opinions, with which they 
are overwhelming him. Aside from this, he reasons with perfect propriety, 
and all his intellectual faculties preserve their wonted integrity. He partici- 
pates in conversation with the same degree of spirit, intelligence and readi- 
ness, as before his sickness. 

Having retired to the country, M. N. passes the summer of 1812 at a 
Chateau, where he receives much company. If the conversation interests him, 
he no longer hears voices. If it languishes, he hears them imperfectly, quits 
society, and turns aside, the better to understand the sentiments which these 
perfidious voices express. He then becomes restless and gloomy. The fol- 
lowing autumn he comes to Paris. The same symptoms beset him during 
his route, and are exasperated after his arrival. The same voices repeat ; Slay 
thyself; thou canst not survive thy disgrace. No, no ! replies the unfortu- 
nate man, I will not terminate my existence until I have been justified. I will 
not bequeath a dishonored memory to my daughter. He goes to the minister 
of police, who receives him with kindness, and endeavors to encourage him ; 
but scarcely does he enter the street, before the voices assail him anew. I 
was invited to visit him, and found him walking with his only daughter in the 
court of the hotel where he lodged. His countenance was of a sallow hue, 
its expression restless, and his eyes haggard. I was received with politeness, 
but to all my questions received no other response than this; " I am not sick." 
On the following day my reception was the same. He said to me, " I need nei- 
ther a physician nor a spy." He was agitated the remainder of the day, and 
conducted his daughter, 15 years of age, to the house of one of his friends. 
That night his disquietude was very great, attended with excitement, sleepless- 
ness, thirst and constipation. The following day, M. N. went early to the 
prefecture of the police, where he declared that he had just settled a pension 
upon his daughter, — that he would not yield to his enraged enemies, who were 
endeavoring to persuade him to take his life, before he had fully justified him- 
self, — that he had just made himself a prisoner, and must be judged forthwith. 
The same day he is committed to my care. 

For more than a month, M. N. does not leave his apartment ; sleeping none, 
eating very little, unwilling to receive any one, and walking with rapid strides, 
like a gloomy and restless man. Do we propose the use of remedies, he re- 
plies with an ironical smile. His politeness in other respects is perfect. His 
conversation is connected, very witty and sometimes gay ; but he never be- 



HALLUCINATIONS. 95 

trays his secret — appears very much engrossed in thought, and particularly 
suspicious of those who serve him. During conversation, he is absent mind- 
ed, and sometimes stops to hear, and replies briefly, with temper and even pas- 
sion, to the pretended voices. After nearly two months, he appeared to wish 
that I should prolong my visits. It occurred to me to call the voices which 
pursue him, babblers. This word succeeds, and at my return he employs it, 
to express their dreadful importunity. I venture to speak to him respecting 
his disorder, and of the causes of its continuance. He relates much in de- 
tail what he has for a long time experienced, is a little more ready to listen 
to my reasoning, and discuss my objections. He refutes my opinion respect- 
ing the causes of these voices, and calls my attention to the fact that they 
were exhibiting at Paris, a woman said to be invisible, to whom they were 
accustomed to speak, and who replied at a distance. Such advances, said he, 
have been made in physics, that by the aid of instruments the voice may be 
transmitted very far. You have traveled, said I, a hundred leagues by post, 
and upon pavement, and the noise of your carriage would have prevented your 
babblers from being heard. Yes, doubtless, he replied, but by means of their 
instruments I heard them very distinctly. 

The new political views, and the approach of foreign armies upon Paris, 
appeared to him fables, invented to get the better of his opinions. Suddenly, 
in the midst of one of our interviews, he said to me, raising his voice, and in 
a solemn tone ; " Since it is your wish, listen to my profession of faith. The 
emperor has overwhelmed me with favors. I have served him with zeal and 
devotion. I have been wanting neither in duty nor honor. This I swear. Let 
him do with me what he pleases." Towards the end of March, 1814, after a 
long conversation, I invite M. N. to pay me a visit, in order to satisfy himself 
by examining my library, whether I was a physician. He»declines; but three 
days after, thinking that he had taken me at unawares, he proposes to visit my 
study immediately. I accept the proposal. After having examined the books 
for a considerable time, he says ; " If these books were not placed here ex- 
pressly for me, this library is that of a physician." Some days afterwards, 
the siege of Paris takes place, but the patient remains convinced that it is not 
a battle, but merely an exercise with fire-arms. The king is proclaimed, and 
I send him the journals with the arms of France ; he reads and returns 
them, adding ; " these journals were printed expressly for me." I reply, that 
this would not only be very expensive, but very dangerous also. This argu- 
ment does not change his mind. I propose, in order to convince him, to walk 
with him about the city, but he declines. On the 15th of April, " Let us go 
abroad," said he to me promptly, and without any suggestion on my part. In 
a moment we directed our steps to the Garden of Plants, where we found a 
large body of soldiers wearing the uniform of all nations. We had scarcely 
walked a hundred steps, when M. N. presses my arm violently, saying ; Let 
us return, I have seen enough, you have not deceived me ; I was sick, but am 
now cured. From that moment the babblers were silent, or were heard only 
in the morning, immediately after rising. My convalescent turned his atten- 
tion from them, with the aid of the shortest conversation, by the perusal of a 
book for a few moments, or by a walk. At this time also, he regarded this 
symptom as I did myself. He looked upon it as a nervous phenomenon, and 
expressed his surprise at having so long been the dupe of it. He permitted 
the application of some leeches, employed the foot-bath, and drank some tum- 
blers of purgative mineral water. 

In the month of May, he goes into the country, where he enjoys perfect 
health notwithstanding the mortifications he experiences, and the affliction 
which the death of his only daughter occasioned. M. N. returns to his coun- 
try in 1815, where he is again called to office. 

This case offers the most striking example of uncomplicated hallucination 



X 



96 HALLUCINATIONS. 

of hearing, that I have witnessed. Hallucination alone, characterized the 
cerebral afiection of the patient. His disquietudes, suspicions and fears, were 
only the consequence of this phenomenon, which persisted for more than two 
months, although the convalescent had entirely recovered the free exercise 
of the understanding. Was this persistence occasioned by the force of ha- 
bit ?* 

M. P., sixty years of age, belongs to a family distinguished in science, and 
was a very noted officer of the marine. He is of medium size, with a pro- 
jecting forehead, and a largely developed occipital region. His hair is of a 
chesnut color, his eyes black, countenance pale, mind highly cultivated, dis- 
position mild. In his youth, he indulged in masturbation, and one of his bro- 
thers committed suicide. 

M. P. at the age of 30 years, made the campaign of 1807 in Prussia, in the 
capacity of an officer of marine. He remained for a long period in a can- 
tonment that was extremely humid, and in consequence was seized with inter- 
mittent fever, attended by delirium. At the age of 31 years, while on leave 
of absence on account of his health, he was married to a charming lady, and 
introduced to a family in which he was treated as a son. Shortly after, he is 
seized with delirium, and attempts to commit suicide. Committed to my care, 
he is restored in three months. On his return to his family, he is the happiest 
of men. He returns to the army, with the rank of Lieutenant of the marine 
guard, and makes the campaigns of 1810 and 1811. In July of the latter 
year, in consequence of an excitement resulting from an act of injustice, he 
suffers from a return of delirium, which terminates with the year. In the 
campaign of 1814, M. P. is named chief of the squadron of the marine guard. 
Soon after, a new attack is provoked by the abdication of Bonaparte. In 
1815 he returns to duty during the hundred days, in opposition to the advice 
of the fimiily of his wife. After the second abdication, M. P., seized anew, 
takes up a frightful aversion to his wife and her family, who were previously 
the objects of his strongest regard. Nothing removes this dislike. He de- 
serts his adopted family, and makes the journey to Rom.e, afoot and alone, 
impelled by religious considerations. Scarcely has he set foot upon the soil 
of Italy, than, one day, overcome by fatigue, he sits down upon a rock, and 
experiences an extraordinary visitation. God appears to him, and he has a 
vision for the first time. From henceforth, he believes that he is followed by 
his father-in-law, who throws in his way every possible obstacle tp the accom- 
plishment of his journey. He sees, hears, and contends with him. Never- 
theless, he reaches his place of destination. Having returned to France, he 
is placed in the hospital at Avignon, where he permits his beard to grow, neg- 
lects the most ordinary attentions which propriety requires, imposes fasts 
upon himself, engages in no occupation, and employs no means of diverting 
his mind. 

\ I visited this hospital in 1821. M. P. remembers and accosts me with 

much satisfaction. He makes many enquiries about my health, and respect- 
ing several persons whom he knew when under my care, eleven years before. 



<? 



^I"- On being brought again to Paris, M. P. enters at Charenton, in 1825. His 
■^ delirium is religious and mystical. A thousand hallucinations and illusions 

of the senses make lio-ht of his reason, and he believes also, that he has im- 



mediate communications with God. The Son of God sometimes appears to 
him ; and he sees him borne upon clouds, surrounded by his angels, with a 
cup in his hand. JJe communicates Ms orders to his humble servant P., not 
by uiords, but by signs which appear in the air. He attempts nothing, with- 
out consulting the God of Heaven. He repeats passages of the Bible, from 

* This case was previously referred to, but the details of it, which we have recorded, ap- 
peared to me of so much interest, that I could not pass it over in silence. 



HALLUCINATIONS. 97 

the gospels, which he opposes to the observations which are made to him with 
respect to his hallucinations and illusions. God expresses himself thus in the 
Holij Scriptures, says he, citing the verse. Having unduly prolonged the 
fast, during the season of Lent, in 1827, M. P. was taken sick. I ordered his 
food to be increased ; but he obeyed not, until he had weighed the matter 
carefully in his mind, had consulted God, and received orders from above, to 
comply with my request. He often said to me, in our interviews ; " Former- 
ly I believed not in God; I was in darkness ; but since I have exercised faith, 
God has given me light." He is constantly in the gardens, contemplating the 
heavens and the clouds, with a blank book and crayon in his hand. He 
traces the symbolical figures, which he sees in the sky. These are, at one 
time, geometrical figures ; at others, animals, household utensils, flowers, in- 
struments of music, and agricultural implements. Again, they are strange 
figures which resemble nothincr. These signs are, moreover, for the instruc- 
tion of men ; for the scripture saith, there shall be signs in heaven. He has 
seen all things created, and understands the creation, and the signs which he 
beholds. He wishes also to explain them, and in his explications, religion 
and politics are constantly blended. He designs all his visions, and writes 
out their explanations. Usually M. P. is calm, polite and amiable. If he 
speaks of his visions, a smile is upon his lips, and his language is mild. He 
expresses himself without excitement, and his terms are very well chosen. 
If we persist in opposing him at any time, his eyes become animated, his look 
is upward upon the clouds, and his face flushed, but never connected with 
uncontrollable excitement. He wears the appearance of a person in the 
higher walks of life ; in person is moderately full, and his hair is white ; his 
appetite and rest are good. He lives retired, and has habitually a pompous 
air ; says little, and never disputes. I have often spoken to him of his wife 
and family, in order to recall his former aflections. They wished me, says 
he, to deny the faith. They are the enemies of God, and I renounce them. 
His costume is strange, in consequence of the variety of its colors. 

We shall not read without interest, an account of the peculiar hallucina- 
tions of a distinguished officer of marine, who has been at Charenton for 
eleven or twelve years. His religious monomania is carried to excess. At 
the age of fifty he is controlled by ideas of a mystical and punitive character. 
He desires to fast, goes about with naked feet, divests himself of his clothing, 
and prostrates himself upon the floor of his chamber. Though usually tran- 
quil, he has had several attacks of madness, which have been caused by re- 
fusing him permission to go to Brest, to rejoin the service. In the spring of 
1836, M. H. sent to me several detached sheets, upon which he had written 
down his hallucinations. The following are certain passages taken from 
them. 

First sheet : " In the name of the Father, of the Son, and of the Holy 
Ghost. 

" Signs of visions, which foretell the reign of God and the coming of 
N. S. J. C. 

" For many years, extraordinary events have been taking place in heaven 
and upon earth. The reign of God and the coming of N. S. J. C. are near. 
God has favored me with many visions which prove it. It is more particular- 
ly within the last years, that I have enjoyed the privilege of seeing God, and 
many of those dwelling in Heaven. 

" How much do I know ! 

" At Orient, in Oct. 1821, about midnight, I heard a loud voice proceeding 
from heaven, which uttered words which I cannot repeat, for I did not com- 
prehend them. A little after, I heard a loud cry, and saw demons, who were 
suffering the chastisements of God. On hearing this voice I arose hastily and 
prayed. The next day I gave my money to the poor. Some days after, be- 

13 



98 HALLUCINATIONS. 

fore sun-rising, I saw in the east, the triangle, emblematic of its divinities. I 
spoke of it to many persons, but my conduct was not at that time sufficiently 
religious, to secure credence to my report. I should have prayed and repent- 
ed, but I did it not. It was not until many years afterwards, that I began to 
instruct myself in matters of religion. I attended mass but little, from shame. 
I have now overcome this diffidence, and have repented." T. H. 

Second sheet : " In the name of the Father, etc. 

" Signs and visions, etc., in 1829. 

" At the close of the month of June, during the night, a man appeared 
over France ; the presence of God was very striking, and I heard some one 
say, is this the end of the world 1 it seems that it may be so. Men had fears, 
and many were troubled. At day-light, the most perfect calm prevailed. A 
few days afterwards I saw persons who hastened over one portion of the sky, 
with armed men. Their march was rapid, and this circuit appeared to be 
made for the purpose of warning men both in heaven and on earth, for I saw 
them in different regions, and in many places. During the whole summer I 
saw angels and saints, in many of the abodes in the heavens. I saw God the 
Father on several occasions, who condescended to speak to me. The first 
time, he was surrounded with great power, and the heavens were clothed in 
brightness. I saw surrounding him, the light of worlds, which before appear- 
ed shrouded in darkness. He afterwards enters divers hells, where he slew 
several monstrous beasts, and filled up those places, from which I believed 
false oracles emanated. His power was every where present, and the heavens 
were shaken by it. Many times I saw John the Baptist in heaven, in a cha- 
riot drawn by seven horses, from whence I believe he was preparing with 
angels, the events that are to precede the coming of Christ. I pray you to 
believe that my visions are true." 

Here follows the signature, T. H. 

I suppress the other sheets. Sometimes the ideas contained in them are 
not more connected nor more rational than those which are to be found above. 
For example, he closes one sheet with this reflection : " I believe that Js. Ch. 
will come, because he has several times been tempted. I pray all the faithful 
to intercede in my behalf" 

Madame de S., of medium size, of spare habit, having chesnut colored hair 
and blue eyes, is endowed with remarkable susceptibility, and with a lively 
•* and very amiable disposition. She menstruated for the first time at 14 years 
of age. She has always enjoyed delicate health, but has been exempt from 
grave maladies. Married at twenty-one years of age, she became pregnant 
at twenty-three, and was happily confined. She did not nurse. Three months 
after her confinement she had an intestinal affection, which persisted notwith- 
standing a hemorrhoidal discharge. At thirty-one years of age, a second preg- 
nancy occurs, during which her disposition becomes sour and capricious. 
She is confined at term, and without accident ; nurses her infant, and is re- 
stored to her former agreeable disposition. Lactation debilitated Mad'e S., and 
the abdominal affection became grave. At thirty-eight years of age, her 
devotional feelings became exalted. She indulged in mystical notions, and 
persuaded herself that she ought to live with her husband, with the view 
only of training up her family according to the commands of God, and charg- 
ing him with being too worldly in his views. Nevertheless she became preg- 
nant the third time, and was happily delivered. Some months after its birth, 
the child died. She had lavished upon it the attentions which excessive 
tenderness inspired, because, said she, this child was born after holy visions. 
To the most poignant grief, succeeded calmness and tranquillity. Her mys- 
tical views were dissipated, and from the age of forty years she enjoyed per- 
fect health until forty-six, when she lost her eldest daughter, who had re- 
cently married. Although filled with despair at this misfortune, she put on 



V 



HALLUCINATIONS. 99 

an air of much resignation, in order to sustain the spirits of her husband, who 
was overwhehned by this affliction. She returns to her religious readings 
with more ardor than ever. She read also several of those pretended politi- 
cal prophecies, which were abroad in the world. These diverse readings, 
made a strong impression upon her mind. She lost both her appetite and 
rest ; and after the month of January, 1817, often spoke of the events fore- 
told with respect to France. At length, in the beginning of March fol- 
lowing, she was present at the anniversary service of the death of her daugh- 
ter. She remains sad, dejected and silent ; without appetite or sleep. Sud- 
denly, on the fifth of March, amidst cries, complaints, convulsions and loqua- 
city, she speaks without ceasing of God, who announces to her extraordi- 
nary events. 

Heaven had been opened to her view. She had seen her daughter there, 
who had informed her that France was about to become subject to a reign of 
grace and justice, — that a Messiah was about to appear, to put himself at the 
head of his church and government, and that all the world would hereafter be 
happy. This state of mind persisted for seven hours, and when restored to 
the use of her reason, it was proposed to her to visit Paris for her health. 
This she obstinately refused to do. As soon however as she was told that God 
commanded it, she immediately descended from her apartment, entered her 
carriage without opposition, and arrived on the sixth, at Paris. On the seventh 
of March, a new crisis occurred, attended by cries, convulsions and halluci- 
nations, together with efforts to escape from her husband and female atten- 
dant. She repulses them, both by her menaces and language ; and beats them 
both, regarding them as devils. Isolation renders her more tranquil, but not 
more rational. She is in despair that the devil should assume the form and 
appearance of her husband, the person whom she loves better than all others. 
She goes readily to the house of M. Pinel, because this celebrated man ought 
to be as well informed as herself with respect to whatever is to happen. She is 
committed to my care. From the first, the new habitation, and the strange per- 
sons who surrounded the patient, impressed her to such a degree, that she did 
not for a moment, betray the thoughts, which had preoccupied her mind. 
She manifested no anxiety at the absence of her husband, nor any uneasiness 
on findincr herself anions strangers. This change of situation, is the fulfil- 
ment of the command of God. 

The next day, the eighth, Mad'e S. expresses a degree of confidence in me, 
and I endeavor to make her comprehend how contrary to the truth her convic- 
tions are, and to impress upon her mind the true object of her stay in Paris. 
She smiles at my error, and with much kind feeling, recommends me to pre- 
pare for great events. Otherwise, she is tranquil, says little, never speaks 
foolishly, but sometimes laughs without cause. She also makes one at a 
game of cards in the evening. She refuses all medicine. On the tenth, after 
a long conversation, in which for the first time, she relates all that she has 
seen or heard, as well as what she has discovered in the Holy Scriptures ; 
after a discussion of sufficient length, she consents to make with me, the fol- 
lowing treaty, which I record, and which is signed by both of us. By the 
terms of this agreement, the patient consents to be regarded as insane, and to 
submit to the treatment that is prescribed for her, if the Messiah does not ap- 
pear before or upon the twenty-fifth of March, and great events do not take 
place at this period. From that day, she is not only calm, but gay; converses 
voluntarily, speaks to no one respecting what is passing in her mind, and sus- 
tains conversation with spirit, and upon every variety of subject. With myself 
only does she sometimes hazard a few words upon her prophesies, and then 
only, from her interest in my future well being. The twenty-fifth of March 
passes by. On the day following, I require the execution of the agreement. 
she submits with the best grace, and testifies a strong desire to see her hus- 



y 






100 HALLUCINATIONS. 

band once more. She sees him on the following day, and appears to us all so 
rational, that she is permitted to return immediately to her province. The 
convictions of this lady are not entirely removed, but very much weakened. 
Having reached home, she resumes her former habits of life, as well in lier 
family as abroad. No one would have supposed that she had been sick, and 
in a very short period the last traces of her malady are completely effaced. 

Madame R. a seamstress, aged forty-four years, is tall, and of a spare habit; 
has chesnut colored hair, eyes hazel and lively, face flushed. Her tempera- 
ment is sanguine, she enjoys very good health, and is of an animated dis- 
position ; but obstinate and choleric. At nineteen years of age, menstruation 
takes place, preceded by violent attacks of cholic. At twenty-two she is mar- 
ried, is seven times pregnant, and has three abortions. At thirty years of age, 
/- while nursing, she engages in a dispute, and has a fit of anger. The secre- 
^^ tion of milk is checked, and a tranquil delirium follows, which persists for 
^ eighteen months; after which she once more enjoyed good health. At forty- 
{ one years of age, whilst walking in the street, during the period of menstrua- 
te" tion, she is thoroughly wet by a pot of warm lye. A suppression of the men- 
^ ,. ses immediately took place, which did not afterwards appear. From this 
-/ time, she suffers from headaches, increases her expenses, purchases articles of 
little use in her family, disputes and quarrels on the subject of politics. Her 
disposition also becomes more irritable and passionate. 

At forty-four years of age, she has a dispute, which is attended by an at- 
tack of ancrer. From that evenincr she suffers from nervous agitation and de- 
lirium. She breaks the windows of her neighbors, is arrested and sent to the 
police office, where she is condemned to pay for the glass she has broken. 
A new attack of anger supervenes, attended with violent delirium, extreme agi- 
tation and loquacity ; she cries, sings, dances, etc. She is brought to Charenton, 
and remains there for five months, in a state of acute mania. Transferred to 
the Salpetriere on the 19th Nov. 1816, the patient is not habitually irrational, 
but in a state of constant agitation, talks incessantly, tears her clothing, and 
torments her companions. Though generally gay, she sometimes weeps. 
She suffers from insomnia, and constipation. She dresses herself in a pecu- 
liar manner, and mentions to any one who wishes to hear her, with the most 
perfect coolness, and in a tone of the deepest conviction, that there is at Cha- 
renton a boarder whom Je.?us Christ has come to visit, and who pays 3000 
francs for her board. Whilst our patient was in this hospital, she also saw 
Jesus Christ. His stature was tall, and his hair brown ; a singular fact, she 
adds, as he is represented in paintings as having flaxen hair, but perhaps it was 
so in his infancy. Jesus Christ has a fine figure, a pretty mouth, and hand- 
some teeth, — his voice and language are mild. He has announced to our pa- 
tient, that there is to be no cold during the winter, — that he will punish the 
Jacobins, by inundating their houses. He appeared to her as a spirit, that 
others might not see him. He was accustomed to come and take her by the 
arm and conduct her to a yellow chapel situated in the garden. He has many 
times stated to her that there would be no more wars, nor misfortunes, the peo- 
ple being converted. Since she has been at the Salpetriere, Jesus Christ has 
visited her every evening, and has promised that there should be an early and 
abundant harvest, the rents of which shall be her own. He has addressed to 
her several letters, (which she has in her possession but will show them to no 
one). He sends into her cell the sweetest odors of jasmine and orange — 
upon its walls, he has caused to be painted landscapes and distant views, and 
illuminates it every evening, with the most brilliant stars. Our patient alone 
has the privilege, either to see, or appreciate these delightful things. 

Mad'lle C. tall and of a slender form, with black hair and large black eyes, 
skin dark and swarthy, bilious-nervous temperament, and delicate lungs, is en- 
dowed with a lively disposition, and an ardent imagination. At the close of 



HALLUCINATIONS. 101 

her first year, she had variola. At twelve years of age, menstruation took 
place, preceding by three months an attack of chlorosis : since which, the 
menses have been both scanty and irregular. At fourteen years of acre she 
became enamored of a young man with whom she had been brought up. He 
dies; and Mad'Ue C, who was at this time sixteen years old, becomes melan- 
cholic, refuses food, and passes several days, at various periods, without takino- 
the least nourishment. She has since been subject to headaches, pains in the 
stomach, sleeps little, and is often awoke by nightmare. She has convulsions 
and syncopes on the slightest opposition, especially after her meals. When 
seventeen )'ears of age, the passion of love was again revived in her heart ; 
and melancholy, together with her other nervous symptoms, disappeared. Her 
health appeared to be excellent. At eighteen years of age she loses her pa- 
rents, and is left without either resources or a guide. To this misfortune, loss 
of appetite succeeds, and the menses become more irregular. Melancholy 
returns, attended with a desire for death, and joy at the thought that she shall 
very soon rejoin her parents. At length delirium supervenes, continuing from 
five to seven hours every day. In the intervals, she refuses to eat, emaciation 
takes place, attended by a pulmonary catarrh, to which leucorrhoea succeeds, 
and an intermittent fever, at first tertian, then quartan, and afterwards quoti- 
dian, with delirium during the attacks. The patient sees her deceased parents 
at her side, which produces the deepest despair. Some friends, in the hope 
of consoling her, offer her religious advice, which she puts in practice. But 
at twenty-one years of age, thwarted in her inclinations, she relapses into her 
former grief and despondency, feels herself overwhelmed by the loss of her 
parents and her excessive misery. It was at this time, that being at church, 
the Holy virgin appeared to our patient, sitting near to God, offering her con- 
solation, and assuring her that she should take her under her own protection. 
The same apparition appeared every day during the delirium of the intermit- 
tent fever, and persisted for more than a year. 

At the age of twenty-three years, perceiving the interest of her lover 
lessening, she is seized with grief ; wishes to die, and refuses nour- 
ishment. After fifteen days' abstinence, she falls into a state which she can- 
not describe. Nevertheless, she with great difficulty gets to the church, and 
while engaged in prayer, notwithstanding her bodily infirmities, and the tu- 
mult of her passions and ideas, God appears to her, and demands of her, in a 
piercing tone, her motive for self-destruction. " Because I am overivhelmed 
with sorrow," she replied. After a long interview, God commands her to 
live, notwithstanding all the sufferings which yet await her. He requires of 
her an oath, that she will not endeavor to destroy herself She takes this 
oath ; and it is remarkable that though she has since experienced many rever- 
ses and mortifications, together with two attacks of lypemania, attended with 
a suicidal impulse, our patient has ever strictly regarded it. When twenty- 
five and a half years old she leaves her province, comes to Paris, and gives 
herself up to libertinism, with all the passion of one possessed of an ardent 
temperament and vivid imagination. Soon after, she becomes pregnant, and 
grieves much. During her pregnancy she has fainting turns every day, and 
becomes dropsical. Nevertheless her confinement is fortunate. From that 
period, she enjoyed miserable health, and believed she was going to die. Be- 
sides, she desires death as an end to her sufferings. At twenty-nine years she 
becomes pregnant a second time. During her pregnancy she suffers greatly, 
has violent paroxysms of cholic, but a happy confinement. She leaves the 
Maternite ten days afterwards. Having returned to her house, alone, forsak- 
en, and without resources, she was plunged into the most profound misery. 
Suffering, and overwhelmed with mortification, she labors night and day, to 
obtain a subsistence. But her feeble and suffering condition, prevented her 
from procuring wherewith to live. She betakes herself to the church, and 



102 HALLUCINATIONS. 

there for three hours prays to God, promising to go forth, confess herself, 
and be converted. She leaves the church with more courage and resolution, 
and sets herself to work with increased ardor. A few days after she was 
seized with a fever, and for several days took no food. She then, as she had 
formerly done, sees God, who appeared to her at eight o'clock in the morning. 
She is transported to the sixth heaven ; sees things more beautiful than she 
can describe, and the recollection of which still fills her soul with inexpressi- 
ble delight. This rapturous frame continues for more than nine hours. God 
appeared to her at several other periods. Jesus Christ visits her more fre- 
quently, gives her advice, and commands her to address the people. She 
passes several days without eating, because, being in communication with 
God, she thinks herself able to do so. She wishes to labor, but is unable to 
effect her purpose in this respect, notwithstanding her great necessity. 

She has the same visions for three successive weeks. On the 28th of April 
she becomes very much agitated. On the 30th, she sings at the window of 
her chamber, and in the evening, declaims, announcing woes to the people ; 
speaking in turn of the impropriety of her past conduct, and of her present 
virtue and penitence. She arms herself with whatever comes to hand, threat- 
ening to exterminate those who approach her, and whom she treats as profane 
persons. Turning against her acquaintances who press around her, anxious 
to lend their assistance, she repulses them with horror. Her own sister is 
repelled with contempt and rage. On the 1st of May, a physician having 
come to visit her, she commands him to announce, in the name of God, the 
evils that threaten France. Her agitation and the perversion of her ideas are 
at their height. On the 3d of May she is sent to the Hotel-Dieu, from 
whence she is transferred to the Salpetriere. At the period of her arrival, the 
5th of May, she sings and talks incessantly, and holds religious discourses, 
. mingled with some degree of obscenity. She is emaciated, her complexion 
/ sallow, her skin hot, and tongue red. She is anxious to perform miracles and 
/ to cure all that are sick. Tepid baths, diluent drinks, pediluvia, etc., are pre- 
scribed. On the 15th there is general delirium, agitation, loquacity, cries and 
f songs. On the 17th, all the symptoms are exasperated, the menstrual flow 

takes place, and the discharge is abundant. On the 30th of May, there is an 
alternation of agitation and repose. God has commanded her to warn the 
Emperor, — she knows those who are to betray him, and will denounce them. 
She is acquainted also with the expenditures of the State, and those who 
are to ruin it. She speaks with haughtiness and pride, and in threatening lan- 
guage. Her countenance is very much flushed, she is greatly agitated, walks 
about rapidly, spits often, and suffers from constipation and insomnia. At the 
end of June the menses return ; in July the same. Continuation of tepid baths, 
cold lotions to the head, and cooling drinks. August : calm and patient ; replies 
correctly to questions that are addressed to her. September : sleeps ; return of 
reason, convalescence, cephalalgia. December : health perfect, and she gives 
an account of her delirium. God appeared to her very often during her last 
attack, spoke to her, and unfolded to her the future. He had the form of a 
venerable old man, clad in a long, white robe. During the following winter 
her health continues good, and she leaves the hospital April 13th, 1815. 

Scarcely has she departed, when, finding herself in the same state of abandon- 
ment and destitution as formerly, the same emotions and ideas also return. Our 
patient is seized with the desire of announcing to Napoleon, what God had 
_ commanded her to say. She attempted oflen to penetrate even to the inte- 

)C< rior of the Tuileries. Not succeeding in this, she wrote a letter which she 

addresses to the Emperor, and another to the high chancellor, demanding of 
him the means of enabling her to reach Napoleon. I have still in my pos- 
session the reply of the high chancellor, but the patient dared not execute 
the instructions therein contained. At the review which precedes the de- 



HALLUCINATIONS. 103 

parture for Waterloo, she forces the ranks, and commits with dignity to the 
hands of an officer a, packet of letters, to the address of Bonaparte. Sup- 
posing that at length her counsels have succeeded, she believes that she has 
saved France. She is composed for some time. But calamity pursues her 
at every step ; and finding no occupation, she relapses again into lypemania. 
She desires to destroy herself, and many times goes to the river for this pur- 
pose. But the recollection of the oath vv'hich she took at the age of twenty- 
three, restrains her. She reenters the Salpetriere on the 21st of June, 
1815, in a most deplorable state, especially with respect to her physical con- 
dition. Milk, together with sufficient nourishment, tepid baths, and cooling 
drinks with gentle laxatives, promptly restore the vital forces. In the month 
of August the patient is better and begins to labor. In the month of Sep- 
tember the menses are reestablished, the delirium has ceased, and cheerful- 
ness is restored. During the winter she is affected with cephalalgia and 
scurvy. For one year this woman, aged thirty-three years, was employed in 
the service of the division for the insane, and enjoyed her reason perfectly. 
But her disposition is very irritable, and she is capricious and erotic. She 
remains so fully convinced of the truth of what was announced to her, that 
she said to me one day, (1817) ; " I shall be insane for two years more, until 
time has proved that all that has been predicted to me is only insanity and 
error." In 1819, she wrote with her own hand a long history of her physical, 
intellectual and moral infirmities, from which the extract I have just given 
was taken. 

M. D., doctor in medicine, tall, of a strong constitution and sanguine tem- 
perament, having a voluminious head, forehead very bare, projecting more on 
one side than the other, with blue eyes, flushed face, and having a violent 
and obstinate disposition ; is an ultra partisan of the doctrine called physiolo- 
gical. He does not content himself with spreading abroad this doctrine by 
his opinions and writings, but wishes to advance it also by his example. He 
bleeds himself from time to time, subjects himself to an abstemious diet, 
and bathes frequently. He had challenged to a duel his associates, who, in 
consultation did not partake of his medical opinions. Thirty-six years of 
age (Aug. 1822) : paralysis of one eye, and of one of the commissures of 
the lips, with transient delirium. Thirty-eight years of age (Sept. 1824) : 
after a violent contest, which took place at a consultation, he was suddenly 
seized with delirium and a nervous agitation. Having returned home, M. D. 
is desirous to bleed his wife, children and domestics, and takes from himself 
several pounds of blood. From this time, he suffers from inappetence, sleep- 
lessness, extreme turbulence, entire incoherence of ideas, and hallucinations. 
Eight days afterwards, he is brought to Charenton. At the time of his 
arrival his agitation is very great, and his loquacity continual. The patient 
pretends to recognize every one, and treats the attendants haughtily and in a 
passionate manner. He experiences hallucinations of hearing and of sight, 
— has a consciousness of his condition, and reasons justly. Towards the end 
of the month he becomes furious, and threatens to slay all who approach him. 
Forty years of age (Oct. 1826) : M. D. believes he sees a patient of the 
house insult and violate his wife. In a furious passion he throws himself 
upon the innocent object of his wrath, and injures him most seriously. Forty- 
one years of age (April, 1827). He has had several attacks of intermittent 
fever, which seem to compose him without lessening the delirium. 

When the medical service of the maison royale at Charenton devolved on 
me, the condition of M. D. had not changed. His physical condition was 
good. On seeing him for the first time he appeared contented, and testified 
much confidence in me ; but although he always expressed the same senti- 
ments towards me, and pretended to feel great deference for me, I could 
never induce him to pursue a regimen and to take remedies appropriate 



104 HALLUCINATIONS. 

to his condition. I earnestly desired to contribute to his cure, and paid him 
particular attention. Nothing however could induce Jiim to lay aside his 
hallucinations, nor could any thing control his medical exaggerations. He 
often requested me to order him to be bled. My refusals, the motives to 
which I endeavored to explain, did not discourage him. His entreaties were 
most urgent during the summer of 1827. At length, after many evasive re- 
plies, I yielded, hoping to strengthen the confidence of the patient, and to 
make myself master of his reason. It was agreed between us that we should 
employ a small bleeding by way of experiment. It was performed one day 
during the month of October. Scarcely had the pupil who performed the 
duty retired, than our enthusiast removed the bandage, and fills with blood a 
chamber pot, a tin wash hand basin, bleeds a large quantity upon the floor of 
his chamber, and feeling enfeebled, reclines upon his bed, where he loses still 
more. Attracted by a slight plaintive noise, the attendant hastens thither and 
finds him extended upon his bed, and almost without life. The pupils, on be- 
ing informed, find in turn the patient w^ithout pulse or respiration ; his face 
pale, eyes glazed, limbs flaccid, and regard him as dead. Nevertheless, they 
employ frictions, at first dry, then of aromatics and alcohol. They employ 
irritant frictions on different regions of the body. The patient is also enve- 
loped in wool. After long and painful efforts, the respiration becomes dis- 
cernible, the pulse perceptible, and a few drops of liquid are conveyed to the 
stomach. After some hours spent in attentions of this nature, the patient 
seems to revive ; pronounces some words, but is voiceless. By degrees, the 
vital forces are reestablished, the voice returns, and the senses resume their 
functions, excepting that of sight. The patient remains blind. As soon as 
he could describe his feelings, (which was only after the expiration of several 
days), he declares himself well, with the exception of a slight weakness. He 
manifests no regret at his loss of sight, assuring us that it will return. Not- 
withstanding his anaemic condition, which continues for several months, and 
the privation of sight, the delirium undergoes no change. His hallucinations 
are equally intense and coherent. Their character also remains the same, 
and he is incessantly excited by those of sight and hearing. The patient 
is perpetually in conversation with persons whom he sees and hears. Habitu- 
ally contented and happy, he often laughs aloud, applauds and claps his hands. 
He never complains of his situation. He remains exceedingly irritable, ready 
to fall into a passion on the least contradiction. All the functions of nutri- 
tion are well performed ; yet he sleeps little, and takes little exercise ; doubt- 
less in consequence of his recent infirmity. This state persists with little va- 
riation for several years. 

Forty-two years of age (1828) : Intestinal catarrh, attended with a very 
abundant discharge of mucus, which much enfeebles the patient. Forty-nine 
years of age (June, 1835) : During the night, cerebral congestion takes 
place. At my visit on the following day, the lips are found to deviate towards 
the left, and the sensibility is obtuse. It is necessary to pinch the skin vio- 
lently to produce pain, and the hearing is very much enfeebled. We notice 
many breaks in the pronunciation of words. The face is pale, the eyes be- 
dewed with tears, the pulse strong, frequent and regular. The skin is warm, 
and the patient somnolent. He expectorates copiously, and is constipated. 
This condition is not of long duration. From this period, intelligence is en- 
feebled, the patient is less gay, and his gayety is of a less blustering charac- 
ter. He both hears and understands with more difficulty, and does not so 
readily recognize by the voice the persons who approach him. He lies most 
of the time upon his bed, and has no regard to propriety. He has little ap- 
petite, and sometimes refuses nourishment. Digestion also is imperfectly per- 
formed. He becomes emaciated, and is affected with a diarrhoea, but the 
hallucinations and delirium persist. Fifty years of age (16th March, 1836) : 



HALLUCINATIONS. 105 

After several days of prostration of the vital forces, and diarrhoea, the dejections 
become involuntary. He remains drawn up in bed, is no longer heard to 
speak, — becomes speechless and dies. 

Seventeenth March, 1836 : Autopsy. The cranium is found to be spongy, 
and a serous discharge takes place on opening the arachnoid membrane. A few 
lines from the apophysis of the crista galli, an ossification presents itself. It 
is of a conoidal form, oval, two lines in thickness, and an inch and a half in 
circumference. It adheres by its base, to that portion of the dura-mater, 
which forms the fold of the great falx. The arachnoid is infiltrated, thicken- 
ed, and opake in some points. There are also points of adherence between 
the pia-mater and the cortical substance of the brain. These adhesions, 
which are very numerous at the base of the brain, are of greater extent at the 
superior region of the hemispheres, especially in front. On removing these 
adhesions, the cortical substance has an ulcerated appearance. It is also red. 
In those portions where the dura-mater has not formed adhesions, the cortical 
substance presents a silvery-grey aspect. If we scrape it with the back of 
the scalpel, it breaks into numerous fragments, and that portion which re- 
mains adherent to the grey substance, seems to be ulcerated, as I remarked 
above. The origin of the seventh pair of nerves, presents nothing special. 
The optic nerves are greyish, and present the color and transparency of wet 
parchment. They are flattened and atrophied. Stripped of the neurilema, 
they are firm, consistent and greyish. This color and consistence extends 
even to their connection with the optic thalami. These, when laid open, pre- 
sent nothing remarkable. The white substance of the brain presents nume- 
rous vessels, from which escape drops of serous blood. The color of this or- 
gan is dull, slightly shaded, violet colored in some portions, and its consistence 
is generally more firm than in the natural state. The grey substance of the 
interior of the brain is of a rose color. The cerebellum, cerebral pedun- 
cles, tuber annulare, the medulla oblongata and spinalis appear in their nor- 
mal state. 

From these facts, and from all that we can gather from the annals of the 
infirmities and diseases of the human mind, we may conclude that there ex- 
ists a certain form of delirium in which individuals believe that they per- 
ceive, sometimes by one sense, sometimes by another, and sometimes by seve- 
ral at once, while no external object is present to excite any sensation what- 
ever. Thus, a man in a state of delirium hears persons address him, asks 
questions, replies, holds a continued conversation ; distinguishes very clearly 
reproaches, abuse, threats and commands which are addressed to him, — dis- 
cusses questions, is vexed, and falls into a passion. He hears also celestial 
harmonies ; the songs of birds, a concert of voices, and this, when no voice 
is near, and a profound silence reigns around. Another sees pictures most 
varied in character, and most animated in expression. Heaven opens, and 
he contemplates God face to face, takes part in exercises of the Sabbath, and 
rejoices at the sight of a beautiful painting, of a fine exhibition, and on be- 
holding a friend. He is frightened at the sight of a precipice, of flames ready 
to consume him, of enemies armed to assassinate him, and of serpents who 
would devour him. Yet this wretched man is in the deepest darkness. He 
is deprived of sight. 

One insane person thinks he sees a shining chariot, which is going to con- 
vey him to heaven. He opens his window, advances gravely to enter it, and 
falls to the ground. Darwin relates the case of a student at Berlin, who, pre- 
vious to the period referred to, had enjoyed good health. This young man 
entered his house in an extreme fright, his countenance pale, his eyes wander- 
ing, and assuring his companions at the same time that he should die in 
thirty-six hours. He retires to bed, orders a minister to be sent for to recon- 
cile him to his God, and makes his will. His symptoms, in appearance grave, 

14 



106 HALLUCINATIONS. 

alarm his comrades. Hufeland visits the patient, but his reasonings do not 
convince him. This celebrated physician orders a dose of opium, which pro-* 
duces a profound sleep, which is prolonged much beyond the thirty-six hours. 
On waking, they succeed in proving to the patient that he has been the sport 
of his imagination. When fully convinced, composure returns to his mind, 
his fears are entirely dissipated, his usual cheerfulness returns, and he con- 
fesses, that having gone out of the city at the dusk of evening, he saw a death's 
head, and heard a voice saying ; " Thou shalt die in thirty-six hours." 

One laboring under a hallucination, desires that certain odors which annoy 
him should be removed, or else he smells those of the sweetest character, while 
there is not at hand any odoriferous body. Before his sickness he was de- 
prived of the sense of smell. Another believes that he chews bloody flesh, 
grinds arsenic, and devours earth : sulphur and flame set his mouth on fire. 
He also quaffs nectar and ambrosia. A melancholic sees bees constantly 
issuing from his mouth. A maniac, hearing the roar of thunder, exclaimed; 
"a thunderbolt has fallen upon my head, without injuring me." He believed 
that he slept with several women successively ; conversed as if they had been 
present, praising one for her promptitude, chiding another for her delay, and 
addressing each in a manner suited to her character. Now he was gay ; of- 
ten jealous, sometimes choleric. While walking in the garden, this patient 
was accustomed to believe that he was present at a feast, and was in raptures 
at the delicacy and variety of the dishes that he smelled. It is the halluci- 
nated who experience asperities, points, and arms which wound and lacerate 
them, whilst lying upon a soft bed. They are carried far away, and think 
that they hold in their hands bodies which are not in their possession. Some 
monomaniacs and epileptics, at the commencement of their attacks, believe 
that they are struck and beaten. They display their bodies which they be- 
lieve have been greatly injured by the cruel blows which they have received. 
A general believed that he had hold of a robber, and shook his arms violently, 
as if he had hold of some one whom he wished to throw upon the ground. 

In general, these individuals believe that both persons and things are present 
with them, which can have no real existence, except in their own imagina- 
tions ; at least, so far as they are concerned. The evidence of the senses, 
passes for nothing in this form of delirium. This class of patients have to 
contest every thing with the external world. They are in a state of halluci- 
nation. Such are the hallucinated. The phenomena of hallucination are 
not like those which result from delirium. In the latter, sensations become 
modified and changed, so that the perceptions of the patient are no longer 
what they were before his illness, nor like those of other men. Notions rela- 
tive to the qualities and properties of things, and of persons, are imperfectly 
perceived, and the judgment in respect to them consequently incorrect. The 
insane man mistakes a windmill for a man ; a hole for a precipice ; and clouds 
for a body of cavalry. In the last case the perceptions are incomplete ; hence 
an error. The ideas and actual sensations are but imperfectly connected. 
In hallucinations, sensation and perception no more exist than in reveries and 
somnambulism, since external objects do not act upon the senses. A thou- 
sand hallucinations sport with and mislead the mind. In fact, hallucination 
is a cerebral or mental phenomenon, which is produced independently of the 
senses. It persists, although delirium may have ceased, and reciprocally. 
The history of many celebrated men confirms this view, and proves that a 
man may be subject to hallucinations without delirium. The first observation 
furnishes a very remarkable example in illustration of this opinion.* » 

The most rational man, if he will observe carefully the operations of his 

* M.Lelut reports several cases of hallucination witliout delirium, in his work : " Tht 
Demon of Socrates." 



HALLUCINATIONS. 107 

mind, will sometimes perceive images and ideas the most extravagant, or as- 
sociated in the strangest manner. The ordinary occupations of life, the la- 
bors of the mind and reason, divert the attention from those ideas, images 
and phantoms. But he who labors under a delirium, — who raves ; unable to 
command his attention, can neither direct it nor turn it aside from these ima- 
ginary objects. He remains the slave of his hallucinations and reveries. The 
habit of always associating the sensation with the external object that solicits 
and usually calls it into exercise, lends a reality to the productions of the im- 
agination or memory, and persuades the subject of hallucinations that what 
he actually experiences could never occur, without the presence of external 
bodies. The pretended sensations of the hallucinated, are the images and 
ideas reproduced by the memory, associated by the imagination, — and person- 
ified by habit. Man then gives a form to the offspring of his mind. He 
dreams, while fully awake. In a case of revery, the ideas of the waking hours 
continue during sleep; whilst he who is in a complete delirium is in a revery, 
though awake. Reveries, like hallucinations, always reproduce former sensa- 
tions and ideas. As in a revery, the series of images and ideas in hallucina- 
tions is sometimes regular ; but more frequently they are reproduced in the 
greatest confusion and present the strangest associations. The hallucinated 
are sometimes conscious, as is the case also in a revery, that they are in a deli- 
rium, without the power to disengage the mind. He who is in a revery, as 
well as he who has hallucinations, is never astonished nor surprised at the ideas 
or images which occupy his mind, whilst they would have excited the greatest 
wonder had the patient been fully aroused, or had he not been delirious. This 
phenomenon, in either case, is caused by the absence of every accessory idea, 
and every foreign impression, with which he who labors under either of these 
forms of disease can compare the objects of his revery or delirium. The 
thinking faculty is altogether absorbed by these objects. The difference be- 
tween the hallucinated and somnambulists consists in this ; that in the greater 
number of cases the former recall whatever has preoccupied or troubled their 
mind, while the latter remember nothing. Hallucinations differ from ecstasy 
in this only, that the latter condition is always produced by a powerful effort 
of the attention, fixed upon a single object, towards which the imagination of 
the person affected constantly tends. In ecstasy, the concentration of inner- 
vation is so strong, that it absorbs all the powers of life, and the exercise of 
all the functions is suspended, except that of the imagination. 

In hallucinations, on the contrary, for the augmented action of the centre of 
sensibility, a violent effort of attention is not necessary. All the functions are 
performed with more or less freedom ; the man lives amid his hallucinations 
as he would have done in a world of realities. The conviction of the hallu- 
cinated is so entire and sincere, that they reason, judge and decide with re- 
ference to their hallucinations. They also arrange, with reference to this psy- 
chological phenomenon, their thoughts, desires, will and actions. At a time 
when it was customary to burn sorcerers, and those possessed of demons, they 
have been seen to throw themselves upon their funeral pile, rather than deny 
that they had engaged in religious exercises. I have known persons who had 
been cured of their hallucinations, who were accustomed to remark, " I saw 
and heard, when laboring under this delusion, as distinctly as you see and hear." 
Many give an account of their visions, with a coolness that belongs only to the 
most entire conviction. Hence results the most singular language and ac- 
tions; for hallucinations, like actual sensations, produce among the insane 
eil^her pleasure or pain, love or hatred. Thus, one rejoices, laughs aloud, and 
finds himself the happiest of men. Soothed by so lively and distinct an im- 
pression of good fortune is he, that, incapable of indulging in any foreign 
thought, he sees no limit to his felicity, and believes that it can never end. 
Another grieves, laments, and is in a state of complete despair ; overcome by 



108 HALLUCINATIONS. 

the frightful hallucinations that press upon him. It is the more profound, as 
he finds himself confined to a dreadful condition, which is overwhelmino- 
him, and from which there is no relief He can see no compensation nor 
any limit to his sufferings. Lypemaniacs also, believe that nothing can chano-e 
their lot, neither to deprive them of the prosperity which intoxicates them, nor 
to withdraw them from the trying condition in which they groan nio-ht and 
day. Many believe that they shall never die. We have at the Salpetriere a 
woman who demands that she may be cut in pieces, because she knows not 
what will become of her when, every body being dead, she shall remain 
alone upon the earth. 

But hallucinations have not always the character of a fixed idea, or of a 
prevailing passion. Sometimes they extend successively to the recollections 
of objects, which have made impressions upon the senses, and give to the de- 
lirium a character of versatility, which is remarked both in their sentiments 
and actions. This happens in certain forms of mania and febrile delirium. 
Thus, there are patients whose hallucinations from time to time are found to 
change their object. 

Hallucinations are therefore neither false sensations, nor illusions of the 
senses ; neither erroneous perceptions, nor errors resulting from organic sen- 
sibility, as is the case in hypochondria. We may confound hallucinations 
with illusions of the senses, or with the false perceptions of hypochondriacs. 
The latter believe in the presence of external objects, or in a lesion of the 
sentient extremities ; whilst in hallucinations, not only are there no external 
objects really acting upon the senses, but sometimes the senses no longer per- 
form their functions. I once had in charge an aged merchant, who, after a 
very active life, was seized with amaurosis at about forty-one years of age. 
Some years afterwards he became a maniac. He was very much agitated, 
and spoke in a loud voice with persons whom he believed he both saw and 
heard. He beheld the most singular objects, and his visions often threw him 
into a complete state of enchantment. There was at the Salpetriere in 1816, 
a Jewess, thirty-three years of age. She was blind, and also a maniac. Ne- 
vertheless she saw the strangest sights. Her death took place suddenly. I 
found both the optic nerves atrophied from their decussation to their entrance 
into the globe of the eye. In this case certainly, the transmission of impres- 
sions was impossible. The same is true with deaf persons, who believe that 
they hear people speaking. We have at this moment at the Salpetriere, two 
women perfectly deaf, who have no other delirium than that of hearing divers 
persons, with v^^hom they are disputing both night and day. They often, in- 
deed, become furious. This frequently happens during sleep, with this diffe- 
rence, that at this time the senses are shut, and are not impressed by external 
objects ; whilst in delirium, the senses, although open to impressions, not be- 
ing attentive, are, as it were, inaccessible to them, and even, in some sort, re- 
pulse them. But in both cases the effects are the same. 

The seat of hallucinations not being at the extremities of sensitive organs, 
must be at the centre of sensibility. In fact, we cannot conceive of the ex- 
istence of this symptom, but in supposing the brain to be acted upon by some 
cause. The brain may be set in action by a sudden and violent commotion, 
by a strong mental conflict, or by vehement passion. It is wrought upon also 
sympathetically, in consequence of the peculiar condition of certain organs 
more or less remote from it. This takes place in the sympathetic forms of 
insanity, in fevers, in the phlegmasia?, or by the ingestion of certain poisons. 
Darwin says, that hallucinations proceed, probably, from the origin of tjjie 
nerve of sensation, which is the most susceptible to attacks of inflammation.* 

* Doctor Foville, in the excellent articles on insanity witfi wliich he has enriclied the 
" Dictionary of Practical. Medicine and Surgery," says " that lie has discovered lesions of 
the nerves in hallucinations." Might not this be a simple coincidence ? 



HALLUCINATIONS. 109 

The brain is called into action by a violent impression which excites it strong- 
ly. This excitement may cause either a state of ecstasy in this organ, which 
produces a fixedness of ideas, or a convulsive condition of the brain, which 
gives rise to incoherence of ideas, and determinations most varied and fugi- 
tive. 

Hallucinations relate usually to the occupations, whether mental or physical, 
to which the person suffering from them has been accustomed, or else they 
ally themselves to the nature of the cause that has kindled up the excitement 
of the brain. A woman has read the history of sorceries, and is wholly en- 
grossed with those religious duties in which she is to take part. She sees her- 
self transported thither, and participating in all those rites by which her 
mind is fascinated. A lady reads in a journal an account of the condemna- 
tion of a criminal. She sees every where the bloody head separated from 
the body, and covered with black crape. This head projects over her left 
eye, and inspires her with such inexpressible horror as to cause her to make 
several attempts upon her life. 

Hallucinations may result moreover, from the repetition, either voluntary or 
otherwise, of the same cerebral movements. These may be frequently repeat- 
ed, in order to acquire a certain kind of information, or to examine some sub- 
ject ; many examples of which we find in the lives of contemplative men. 
Habit renders these movements easy, and even involuntary, as it does certain 
organic actions. The action of the brain prevails over those of the senses, 
destroys the effect of present impressions, and causes him who labors under 
hallucinations, to regard the effects of memory as actual sensations. From 
this time the moraf state is perverted, and there is delirium. We notice 
among the hallucinated a sort of eccentricity, as we do among the most ra- 
tional men, who are absorbed in some profound meditation. 

The man whose delirium has for its object an exalted passion, no longer 
perceives any thing. He sees and hears, but these impressions do not reach 
the centre of sensibility. The mind does not react upon them. The man 
who is subjected to the influence of a controlling passion is altogether en- 
grossed thereby ; is drawn away by it ; is beside himself Whatever does not 
appertain to the series of ideas and affections which characterize his passion, 
is nothing to him ; whilst every thing proper to it is ever present to his mind. 
Here is a" passion which controls the reason, modifies the ideas, and provokes 
the determinations. And as, of all the passions love and religion are those 
which hold the most absolute empire over man, since they affect at the same 
time both his mind and heart, it is not astonishing that religious and erotic 
monomania should be signalized by hallucinations the most strange and fre- 
quent. 

Hallucinations take place among men who have never had dehrmm, but 
they constitute one of the elements of delirium which are most frequently 
found in mania, lypemania, monomania, ecstasy, catalepsy, hysteria and febrile 
delirium. Among a hundred insane persons, eighty at least have hallucina- 
tions. Sometimes this symptom appears a long time before delirium be- 
comes apparent to those who reside with the patients. They often struggle 
against their hallucinations before manifesting or complaining of them, and 
before committing any impropriety either of speech or act. Sometimes at 
the commencement of the disorder, the hallucinations are fugitive and confus- 
ed. With the progress of it, they become as distinct and complete as the 
actual sensations, and are continued and permanent. They not unfrequently 
persist, though the delirium may have ceased. During the most general de- 
lirium, or a very animated conversation, the insane man suddenly checks him- 
self, to contemplate an object which he believes strikes his eye, or to listen 
and reply to persons whom he thinks he hears. This symptom may be ob- 
served amono- almost all those who have delirium. Nevertheless individuals, 



110 HALLUCINATIONS. 

who, before their ilhiess were controlled by a passion, or subject to strong 
conflicts of mind, are more exposed to it than others, especially if they have 
previously applied themselves to speculative and abstract studies. If halluci- 
nations are most frequently the lot of feeble minds, men the most remarkable 
for their strength of understanding, the depth of their reason, and their vigor 
of thought, are not always free from this symptom. 

At one time, the hallucinations seem to depend upon the functional lesion 
of a single sense, — the hallucinated believing only that they hear. At an- 
other, they seem to depend upon that of two and even three senses, — the 
patient believing that he hears, sees, or touches. Sometimes indeed, all the 
senses seem to concur in producing and continuing the delirium. Certain 
facts prove that hallucinations characterize only a particular state of deli- 
rium, — a circumstance which has caused some to regard the hallucinated as 
inspired ; but on continued observation, these individuals immediately betray 
the true cause of their condition. In Germany, we find still among this class 
of the insane those whom they call seers. In the East, and in India, we 
meet with pretended prophets, who are only hallucinated. 

Hallucinations depending upon impressions perceived by the senses of taste 
and smell, are reproduced, particularly at the commencement of insanity. 
But those which appertain to sight and hearing, are more frequent during all 
periods of the malady. Hallucinations of sight, reproducing objects which 
occasion the most general interest, and make the strongest impression upon 
the multitude, have been denominated visions. This name is suited to a sin- 
gle form of hallucination. Who would dare to say, visions of hearing, visions 
of taste, visions of smell ? and yet, the images, ideas and notions, which seem 
to belong to the functional alteration of these three senses, present to the 
mind the same characters, have the same seat, that is to say, the brain, are 
produced by the same causes, and are manifest in the same maladies as hallu- 
cinations of sight, — as visions. A generic term is wanting. I have proposed 
the word hallucination, as having no determinate signification, and as adapted 
consequently, to all the varieties of delirium which suppose the presence of 
an object proper to excite one of the senses, although these objects may be 
beyond their reach. Hallucinations are an indication little favorable to a 
cure in the vesanife. As they are only a symptom of delirium, and may 
exist in many diseases of the mind, either acute or chronic, they do not re- 
quire a particular treatment. They ought nevertheless, to have great weight 
in the intellectual and moral management of the insane, and the therapeutic 
views which the physician may propose. 



ILLUSIONS OF THE INSANE. 



Preliminary remarks.— Illusions, by some authors confounded with hallucinations.— Dis- 
tinction pointed out.— Illusions not uncommon when in a state of health.— Examples. 
—Hypochondriacs suffer from them.— Three conditions necessary for the correct per- 
ception of a sensation.— Remarks on the causes of illusions.- Divided into ganglionic 
illusions and illusions of the senses.- 1. Examples of the former class.— Post-mortem 
examinations.— II. Examples of the latter class.— Proof that illusions depend upon 
the anormal action of the extremities of nerves.— Cases.— Inflammation or other lesion 
of the nervous center or its membranes, often give rise indirectly, to illusions.— Con- 
clusion. 

The insane believe that they see, hear, feel, taste and touch, whilst the ex- 
ternal objects, answering to these sensations respectively, are not within reach 
of their senses, and cannot actually impress them. This symptom is an mtel- 
lectual and cerebral phenomenon, and the senses are not concerned m its pro- 
duction. It occurs, although the senses do not perform their functions, and 
even though they no longer exist. Thus, there are deaf persons who think 
they hear ; and blind, who believe they see. The ancients had observed this 
symptom only in connection with recollections of the sensations of sight, and 
had (riven to it the appellation of vision. But the analysis of thought among the 
insane, (for the insane think and reason), proves that the same phenomenon 
takes place relative to sensations formerly perceived by the sense of smell, and 
those of taste and touch, as well as by that of sight ; a circumstance that has 
led me to give to it the generic name of hallucination. In the essay on hallu- 
cinations, I particularly noticed this psychological phenomenon, and stated facts 
which demonstrated that hallucinations sometimes existed without delirium, 
and characterized one variety of monomania. The ancients did not^ distin- 
guish visions from illusions of the senses. Some moderns adopting the term 
which I proposed as a substitute for visions, have confounded hallucinations 
with illusions; dividing them, indeed, into mental hallucinations (visions), and 
sensorial hallucinations {iUusioiis of the senses). Their authors have not dis- 
tinguished with sufficient clearness, the essential difterence which exists be- 
tween these two orders of phenomena. In hallucinations every thing goes on 
in the brain. Visionaries, and those in a state of ecstasy, are hallucinated. 
They are in a revery, though quite awake. The activity of the brain is so 
energetic, that the visionary or the hallucinated, gives a body and reality to the 
images and ideas that memory reproduces, without the intervention of the 
sens'es. In illusions, on the contrary, the sensibility of the nervous extremi- 
ties is altered : it is exalted, enfeebled, or perverted. The senses are active, 



112 . ILLUSIONS OF THE INSANE. 

and the actual impressions solicit the reaction of the brain. The effects of 
this reaction being submitted to the influence of the ideas and passions which 
control the reason of the insane, they deceive themselves in respect both to 
the nature and cause of their actual sensations. 

Illusions are not rare in a state of health, but reason dissipates them. A 
square tower, seen from a distance, appears round ; but if we approach it, the 
error is rectified. When we travel among mountains, we often take them for 
clouds. Attention immediately corrects this error. To one in a boat, the 
shore appears to move. Reflection immediately corrects this illusion. Hypo- 
chondriacs have illusions, which spring from internal .sensations. These per- 
sons deceive themselves, and have an illusion respecting the intensity of their 
sufferings, and the danger of losing their life. But they never attribute their 
misfortunes to causes that are repugnant to reason. They always exercise 
sound reason, unless lypemania {melancholy) is complicated with hypochon- 
dria. Then delirium is present; and lypemaniacal hypochondriacs have illu- 
sions, and reason incorrectly respecting the nature, causes and symptoms of 
their malady. Illusions, so frequent among the insane, deceive them respect- 
ing the qualities, relations and causes of the impressions actually received, 
and cause them to form false judgments respecting their internal and external 
sensations. Reason does not rectify the error. Three conditions are neces- 
sary for the perception of a sensation. The integrity of the organ which re- 
ceives the impression, the integrity of the nerve that transmits it, and the in- 
tegrity of the instrument which reacts upon this impression. Illusions of the 
senses depend also upon three causes : alteration of the organs of sense, a 
lesion of the nerves of transmission, or an anormal condition of the brain. If 
the sensibility and activity of the senses are aftected, it is evident that the 
impression made upon them by external objects is modified. If the nerves of 
transmission are disordered, and if at the same time the brain is in a patholo- 
gical state, it cannot rectify the error of the senses : hence illusions. If the 
fugitive and brief attention of maniacs does not permit the senses to delay 
long enough upon external objects to make a distinct impression, the percep- 
tion is incomplete, and the qualities and relations of objects which impress 
them will be imperfectly perceived. In monomania, on the contrary, the at- 
tention being too concentrated, cannot transfer itself successively to objects 
external and foreign to the intellectual or affective preoccupations, which 
control the patient. Hence illusions, which reason does not remove. 

The passions, the source of so many illusions among men of sound minds, 
modifying also the impressions, and giving a wrong direction to the reaction 
of the brain, are the cause of a thousand illusions among the insane. The 
understanding and the passions concur with the senses in the illusions of the 
insane; and the sentient extremities are the true points of departure of the 
illusions. There is always an actual impression upon the senses of external 
objects. Let us now see what facts report. They inform us that illusions 
spring from internal and external sensations. I would distinguish them into 
ganglionic illusions, and illusions of the senses. 

<5) I. Perturbations of organic sensibility, internal sensations, often produce 
the illusions of the insane. 

The skin of some insane persons is hot, dry, arid and cadaverous, and im- 
perfectly performs its functions. These patients are indifferent to the ex- 
tremes of temperature. Pinel speaks of a maniac who was accustomed to 
gather up handfuls of snow and rub it upon his chest with delight. Others 
experience such a degree of irritation of the skin, that they think they are to 
be smitten and murdered by the slightest contact. They also persuade them- 
selves that we throw at them substances, or poisons which burn and greatly 
injure them. We have at Charenton an insane woman, who cries aloud the 



ILLUSIONS OF THE INSANE. 113 

moment we touch her with the end of the finger : " You hurt me ! Don't 
strike me, don't strike me," she cries. 

An officer of ordnance, twenty-seven years of age, strong and tall, was 
taken with intermittent fever during the campaign in Prussia. He was re- 
quired to drink a large tumbler of brandy, with which they had mingled the 
powder of two cartridges. M. *** immediately became a maniac. There 
was general delirium, loquacity, cries, rage. He destroyed every thing that 
came within his reach, linen, clothing and bedding. Force had been em- 
ployed to cause him to sleep upon straw. Being pricked by it, he disposed 
the straw in a circle, leaving in the centre a void space, in which he placed 
himself He turned his head in all directions, blowing incessantly upon the 
straw that surrounded him, and from time to time uttering cries, as if to re- 
pulse threatening objects. This symptom persisted both night and day for 
more than three weeks. It was known that the patient regarded each blade 
of straw as the beak of a bird of prey which was wounding him. He blew 
and uttered cries, to frighten and drive away these mischievous animals. At 
a later period, this same patient had new illusions. Scarcely had he retired 
at night than he destroyed his bed, and passed by handfuls the straw of which 
it was made, through the window of his chamber, which was closed by blinds, 
and spoke from time to time as if he was addressing horses. The sound of 
the footsteps of persons whom he heard walking, was taken by him for those 
of horses, who had come to his window as to a rack. The care that was 
taken to remove the straw so soon as he threw it out, kept up the illusion. 
He believed that the horses had eaten it. This patient often looked upon the 
clouds as a body of armed men, and supposed that this army was going into 
Germany when the clouds were blown towards the north, and were marching 
towards England when their direction was towards the west. Those pains in 
different regions of the body which the insane experience, are also the cause 
of illusions amonw them. 

Mad'lle , eighteen years of age, enjoyed good health, although she was 

not regular with respect, to the catamenia. She experienced at the close of 
the events of 1815, a fixed pain in the top of the head, and immediately per- 
suaded herself that she had a worm in her head that was devouring the brain. 
The sight of copper caused a sensation of faintness, and her parents were ob- 
liged to have all the gildings of the apartment removed. She consented to 
walk only with the greatest reluctance, because the dust that was raised by 
those who were walking, was loaded with the oxyd of copper. Nothing could 
induce her to touch an article of copper, a gilded candlestick, or the cock of 
a fountain. Several months' treatment having proved of little benefit, I was 
called to visit her. She was emaciated, slightly pale, and very irritable. She 
sometimes refused to eat, slept poorly, and was constipated. She spoke of her 
peculiar repugnance to certain things, now with vivacity, now with anger, and 
now with tears. I endeavored to gain the confidence of my young patient, 
and at first humored her notions, assuring her that I would destroy the worm, 
the cause of her sufferings, if she had the courage to submit to a slightly 
painful operation. I had so well succeeded in persuading her, that after one 
of my visits, during which 1 had spoken to her of cures obtained by a means 
which I pointed out to her, she raised her head, and with a knife made an 
incision through the scalp. Scarcely does she see her blood flowing when 
she finds herself ill. I was immediately sent for, and repaired to the patient. 
She had recovered her consciousness, and was very desirous that the opera- 
tion should be performed, about which I had been conversing with her for 
some time. Her courage sustains that of her parents, who consent to the 
employment of the means which 1 had proposed. M. Bigot, usually the phy- 
sician of the family, makes a crucial incision of more than two inches in ex- 
tent, over the painful point, and permits the blood to flow. We showed to 

15 



114 ILLUSIONS OF THE INSANE. 

the patient a portion of the fibrine, which we assure her is the worm which 
has cost her so much suffering. An issue was established in the centre of 
the incision, and kept open for three months, after which the fixed pain, illu- 
sions, and her fears of vcrdigri.-^, disappear. 

Some years subsequently, while I was giving my clinical lectures on men- 
tal diseases at the Salpetriere, a similar case presented itself in the person of 
a country woman, who had been admitted into the division for the insane. 
She complained of fixed and very acute pains at the top of the head, which 
she attributed to the presence of an animal ; a circumstance that had thrown 
her into lypemania with a disposition to suicide. I made a crucial incision 
over the painful point. I was careful to show to the patient a fragment of an 
earth worm, assuring her that this was the cause of her sufferings. After the 
operation, this woman showed to her associates the animal from which she had 
been relieved, expressing her joy at being cured. But thirty-six hours after- 
wards, the companions of this unfortunate woman began to ridicule her, and 
to say that I was imposing upon her credulity. She tore away at once the 
issue that had been established, her former pains returned, and with them 
her illusions. 

A general of division, fifty years of age and upward, had become rheuma- 
tic during the war, and was taken with mania accompanied by rage, in con- 
sequence of a moral affection. His teeth were poor, and he often suffered 
from them. He accused the sun of being the cause of the sufferings which 
he experienced, and when his pains were exceedingly severe, would utter 
frip-htful cries and imprecations against this luminary, and threaten to go and 
exterminate it with his brave division. Sometimes the pains were seated in 
one of his knees ; the patient would then seize with one hand the painful part, 
and with the other closed, smite his knee with heavy blows, repeating : " Ah! 
villain, thou shall not escape ! ah ! villain!" He thought he had a robber in 
this knee. 

A lady thirty years of age, and of a strong constitution, having become 
hypochondriacal after severe grief which had occasioned loss of rest, persuad- 
ed herself that her brain was petrified. At a later period, having felt the beat- 
ing of the temporal artery, when lying upon the right side, she concluded 
that her brain was liquified, and that it was running like a torrent. This illu- 
sion was the more remarkable, as she very well knew that such a condition of 
the brain was impossible. 

Gastric and intestinal pains, borborygmi, and troubles respecting the alvine 
evacuations, are also symptoms upon which the insane often found an illusion, 
formino- judgments as false as diverse, respecting the nature and causes of 
these symptoms. Facts on this point are very numerous, and are found in 
every author. 

Ambrose Pare cured a hypochondriac who believed that he had frogs in his 
stomach, by administering a purgative which procured abundant stools, and 
taking the precaution to introduce secretly small frogs in the vessel which 
was to receive the rejected matters. 

I opened the body of a lypemaniac at the Salpetriere, who had believed for 
many years that there was an animal in her stomach. She had a cancer of 
this ororan. There is in the division for the insane at the Salpetriere, a wo- 
man who has for many years suffered from abdominal pains. She assures us 
that she has in her bowels a whole regiment. When the pains are exasperat- 
ed she becomes excited, cries aloud, and affirms that she feels the blows which 
the soldiers give each other in their contests, and that they wound her with 
their arms. 

A woman, about 58 years of age, of a strong constitution and sanguine 
temperament, had become a mother by M. R., at whose house she lived as 
door-tender. This was a source of deep mortification to her. She afterwards 



ILLUSIONS OF THE INSANE. 115 

experienced gastro-intestinal affections, and became a bigot. The events of 
the revolution, concurred, with the cessation of the catamenia, to produce an 
attack of mania. She was brought to the Salpetriere where she passed many 
years. In stature she was small, her neck thick and short, her mind strong, 
and she was of a very full habit. There was something mysterious in the 
expression of her countenance, and she complained of pains at the epigastrium, 
which was sensitive to the touch. She had copious eructations, and was often 
affected with dysmenorrhcea. Habitually calm, she occupied herself in sew- 
ing. They called her in the hospital the 3Iother of the Church, because she 
was constantly talking on the subject of religion. She attributes her suffer- 
ings to the wickedness of Pontius Pilate, (the father of her child). This in- 
famous wretch has taken up his abode in her bowels. She sees him there, and 
every time that she meets me, she beseeches me to expel him. She believes 
also, that she has in her belly all the personages named in the New Testament, 
and sometimes even those of the whole Bible. She often says to me; '^ I can 
hold out 710 longer ; when will the peace of the church come!" If her pains 
are exasperated, she repeats to me with imperturbable coolness; " To-day the 
crucifx'wn of Jesus Christ takes place ; 1 hear the blows of the hammer with 
which the nails are driven." She believes that the popes hold their council in 
her bowels. Nothing can dissipate illusions so strange. At the post-mortem 
examination of this woman, who died March Cth, 181G, the body was in good 
case. I found at the middle and superior part of the occipital region, a de- 
pression, which would admit the extremity of the little finger, but did not ex- 
tend to the internal table. The brain was slightly injected, and the ventricles 
contained a small quantity of serum. The ventricles of the heart were full of 
coagulated blood. The abdominal viscera adhered together, and to the abdo- 
minal parietes, by means of the peritoneal membrane, which was much thick- 
ened. It was impossible to separate the intestines from each other. So strong 
were the adhesions, that they formed a solid, inseparable mass. The liver was 
exceedingly voluminous, extending to the left hypochondrium, where it adhered 
to the spleen. 

I found the same alteration, although the adhesions were less strong and ge- 
neral, in the case of a demonomaniac, who believed that she had several devils 
in her belly, who were rending her vitals, and constantly tempting her to de- 
stroy herself This woman was in a state of extreme emaciation, her skin had 
become embrowned as if tanned, and deprived of all sensibility. I sometimes 
pierced it with large pins without producing the least pain. Seeing herself so 
insensible, this lypemaniac became persuaded that her skin was changed into 
that of the devil. Irritations, pains, and lesions of the organs of generation, 
are, among the insane, and particularly with women, the frequent cause of 
illusions. They have sometimes induced the insane to mutilate themselves. 
Erotic female monomaniacs, experience all the phenomena of a union of the 
sexes. They think themselves in the arms of a lover or ravisher. An hyste- 
rical female monomaniac believed that the devil, serpents and animals, intro- 
duced themselves into her body, by the external organs of reproduction. Can- 
cers, and ulcers of the uterus, are not uncommon among this class of patients. 
The hysterical insane are disposed to attribute, and do sometimes attribute, 
to enemies, to the jealous, and to the devil, the pains and constrictions of the 
throat which suffocate them. The flying pains which they experience in the 
limbs, give rise to the most painful illusions. 

We have at Charenton a monomaniac, thirty years of age, who is persuad- 
ed that he is conducted every night into thej vaults of the opera. There, 
and even sometimes without leaving his chamber, they pierce him with knives, 
plunge poniards into his back and breast, and take off now an arm, now a 
thigh. They even cut off his head. When it is remarked to this unfortunate 
man that his head is upon his shoulders, that he preserves his members, and 



116 ILLUSIONS OF THE INSANE. 

that his body presents no wound nor cicatrix, he replies with animation : 
" These are the wretches, the magnetizers and freemasons, who have the secret 
of readjusting the limbs, so that no evidence of their amputations shall ap- 
pear." If we insist; "You have an understanding, he replies, with these 
monsters and brigands." " Slay me, slay me! I cannot resist the sufferings 
which they cause me to endure, nor their cruelty." The father of this mono- 
maniac, and his former partner, are especially accused by him as the chiefs of 
all the villians who nightly torture him. 

§ 11. After a recital of facts which indicate the part which the internal sen- 
sations perform, in illusions, let us pass to those which take their origin in the 
external senses. The perturbations of animal sensibility, and the impressions 
which come from without, — external sensations are, we remarked in commenc- 
ing, the causes of numerous illusions. Illusions of the external senses are 
not rare with man in a state of health, and are frequent among the insane. 
Reason immediately rectifies the errors of the former, while there is none to 
combat the illusions of the latter. Does the maniac hear a sound, he believes 
that some one is speaking to him, and replies accordingly. Does he hear se- 
veral persons speak ? He believes that they are friends who are hastening to 
deliver him, or subjects who have come to raise him upon a broad shield, and 
proclaim him king. He who suffers from panophobia, believes on the con- 
trary that they address him with reproaches and threats. An unmeaning 
phrase he construes into the expression of a concerted plot against him. He 
thinks he hears enemies, agents of police and murderers, making arrangements 
to arrest and conduct him to prison, or the scaffold. Does a door open ? he 
believes himself lost, and ready to become the prey of those who desire his 
destruction. 

A servant, thirty-one years of age, had lost his employment, by which he 
supported his family, and had come to want. He starts for Paris. Suddenly 
he jumps from the carriage, and insults his traveling companions, who have, 
he says, made remarks disreputable to him, and treated lightly his destitution. 
All of them were, indeed, unknown to him. Having arrived at Paris, he took 
lodgings in the street Bourgogne, but dared not go out of the house, seeing 
in every one he met, spies and agents of police, ready to arrest him. This 
young man was, moreover, very calm and rational on every other subject. 
One day he hears the footsteps of several persons who are ascending the stair- 
way of the house in which he resided. Convinced that they have come to ar- 
rest him, he seizes one of his razors and makes with it several superficial 
wounds in his neck. His sister, who was in the chamber, threw herself upon 
him, when he laid aside the razor, but endeavored to throw himself from the 
window, dragging her with him. The neighbors hastened to them, and placed 
the sick man in bed. He had concealed a pen-knife, with which he inflicted 
several wounds upon the chest, but without penetrating the cavity. One hour 
after, having had his wounds dressed and been bled, he confessed to me that he 
had sought to take his life, only to secure himself from arrest and the infamy 
of the scaffold, for which they came to take him. 

I once had in charge a lady, whom the slightest noise filled with terror, 
especially during the obscurity of the night. The steps of a person walking 
lightly, made her shudder, and the wind caused her to tremble. The noise 
which she herself made while in bed, frightened her, and obliged her to rise, 
and utter cries of terror. I enabled this panophobist to rest at night, by keep- 
ing a light in her chamber, and placing a woman with her, who watched dur- 
ing the'vvhole night. Sight is the sense which provokes the most illusions 
in°a state of health, because it is, more frequently than the others, in relation 
with external objects. Illusions of sight also, are very frequent among the 
insane. They call up resemblances which provoke indignation, fear, remorse 
and fury, and almost always augment delirium. Thus one sees in a relative 



ILLUSIONS OF THE INSANE. 117 

or friend, an unknown person, or an enemy, against whom he has formerly 
had cause of complaint. 

A lady, twenty-three years of age, affected with hysterical mania, was ac- 
customed to remain constantly at the windows of her apartment. It was dur- 
ing the summer. Whenever she saw a beautiful cloud, isolated in the air, 
she would call with a loud voice, " Garnerin, Garnerin, come and seek ?ne," 
and repeat the same invitation until the cloud had disappeared. She regard- 
ed the clouds as the balloons sent up by Garnerin. 

An officer of cavalry, on seeing clouds, regarded them as a body of armed 
men, whom Bonaparte was conducting to the invasion of England. The in- 
sane often collect stones and fragments of glass, which they look upon as pre- 
cious stones, diamonds, antiques, and specimens in natural history, which they 
preserve with the greatest care. We have at Charenton an aged professor, 
who preserves in his chimney an enormous quantity of small stones, to which 
he attaches great value. He distributes them as rewards of great price, and 
is grieved and angry when they are taken from him. He believes that they 
are characters for printing, of which he is unwilling to be deprived. Another 
patient collects stones, snails, broken pieces of glass, and pottery, to make of 
them, he says, a rich collection in natural history. He accuses of ignorance, 
those who do not concur with him in opinion respecting the beauty and rare- 
ness of his specimens. 

Mad'e de C, having reached the critical period of life, was taken with 
hysterical monomania. After some years her delirium changed its character. 
She composed verses, and wrote comedies, which she wished to submit to the 
judgment of the academicians ; causing them to be read to all those whom 
she met, and applauding herself the beauties which her compositions present- 
ed. During the last six years of her life she no longer wrote, but collected 
pebbles, filling the drawers of her furniture with them. From time to time 
'she entrusted one, or several, with me ; boasted of their size and price, and 
advised me to cause them to be sent to the king, in order to reestablish the 
finances of the state. The effects of light, reflected upon the walls of the 
apartment occupied by the insane, or modified by articles of furniture, are 
frequent occasions of illusion. 

A gentleman attacked with hypochondriacal lypemania, was in the habit of 
striking continually with his cane upon the furniture of his apartment, and 
even of the saloon where several persons were assembled. The more rapidly 
he walked the more he struck. I discovered at length that the shadow, pro- 
jected upon the inlaid floor by the furniture, was mistaken by him for rats. 
The shadow of the patient passing between the furniture and the light, caused 
him to think that the rats were very numerous, and he then struck to frighten 
them. The more speedily he moved, the more rapid were the flickerings of 
the light, and the more firmly did the patient believe that the number of rats 
had increased. 

I had in charge at one period a young lady who was occupied much in art 
and literature. Her imagination was very active. She was a maniac, and 
passed the night without sleep, ravished with the beautiful pictures which she 
saw designed upon the curtains of her bed and windows. She expressed aloud 
her rapturous delight. I enabled her to rest, by depriving her of light during 
the night. 

A young lady, laboring under a second attack of mania, very often refused 
the food with which she was served. On enquiring the reason, she replied 
that it sometimes bristled with pins and needles. 

The insane are often unable either to read or write ; nor can we always at- 
tribute it to weakness of the brain, or feebleness of the reason. In some in- 
stances it happens that when the patient attempts to read or write, the letters 
mingle together confusedly, or rather move about, as if they were springing 
from the paper. It is this circumstance evidently, that prevents them froni 



118 ILLUSIONS OF THE INSANE. 

either reading or writing. But are these illusions the result of the anormal 
action of the eyes, an action which the cerebral reaction does not rectify 1 
The two following facts furnish a sufficient reply to this question. Reil re- 
lates that an insane lady had attacks of excitement and even fury. Her wait- 
ing woman, wishing on one occasion to restrain her mistress, placed her hands 
over her eyes. The patient immediately came to herself, and was perfectly 
calm, saying that she no longer saw any thing. The physician, instructed by 
this phenomenon, tested it himself, and was convinced that the agitation of 
this patient was produced by disorder of sight, which represented frightful 
objects to her vision. 

I once had charge of a young soldier, allied to the family of Bonaparte. 
After many errors of regimen and reverses of fortune, he became a maniac 
and was committed to my care. He saw in every one around him a member 
of the imperial family. He was excited and indeed enraged, when he saw 
the domestics fulfilling any servile duty. He prostrated himself at the feet of 
one of them whom he took for the emperor, and demanded favor and pro- 
tection. It occurred to me one day to bandage his eyes with a handkerchief 
From that moment the patient was calm and tranquil, and spoke rationally of 
his illusions. I repeated the same experiment several times, and with the 
same success. On one occasion among others, I kept the bandage for twelve 
hours over his eyes, nor did he speak irrationally during the whole period. 
So soon however as he could see, the delirium commenced again. 

The sense of smell, like the other senses, deceives the insane. This class 
of patients are very suspicious, and refuse their food, because they find it of 
a disagreeable odor. They in general smell of both the food and drink 
which are offered them, before tasting, and sometimes dash them away with 
fury, believing that they discover the presence of poison. Many insane per- 
sons, on smelling the gases diffused in the air, regard them as unwholesome, 
and suited to poison them. One of our patients who suffers at times from 
dyspnoea, often remarks to me : " / knmv not tvhctt there is in the air, but I 
cannot breathe. It contains a mephitical qualiti/, which takes aivay my respi- 
ration. I am dreadfully emaciated, and shall die on account of this condition 
of the atmosphere." 

I have seen the insane, when very much agitated and restless, composed by 
agreeable odors diffused around their apartments. Almost always at the com- 
mencement, and sometimes in the course of mental disorders, the digestive 
functions are primitively or secondarily affected, and the insane find an un- 
pleasant taste in all the food which is presented them ; whence they conclude 
that their aliment is poisoned, and reject it with fury or with dread. This 
phenomenon provokes moreover, among these patients, an aversion to those 
who have the care of them ; and this is the more violent, in proportion as 
those persons were more dear and devoted to them. Is there any thing more 
dreadful than the fear of being poisoned by those we love 1 This dread and 
refusal of food ceases after a few days, either by change of diet or after eva- 
cuations, by which the gastric embarrassment or irritation of the stomach is 
dissipated. This symptom, so trying to those who are not in the habit of ob- 
serving the insane, is not one of serious import. It is not alarming like the 
obstinate refusal of some monomaniacs, who do not eat, either in obedience 
to a fixed idea which controls them, — such as an expiation, the fear of failing 
to fulfill a religious precept, or in consequence of some principle of honor, or 
to terminate their existence. It happens also, that the dryness and aridity of 
the mucous membrane of the tongue and mouth, persuade some insane per- 
sons, that earth has been mingled with their aliments, and that it is desired 
that they should eat of tainted food ; whilst in other cases, particularly in de- 
mentia, the sense of taste being destroyed, the patients eat the most disgust- 
ing and foetid substances. 

The sense of touch, so often appealed to by the reason, to dissipate the 



ILLUSIONS OF THE INSANE. 119 

errors of the other senses, sometimes deceives the insane. I have already 
cited several facts, which demonstrate that the perversion of the sensibility of 
the skin causes numerous illusions respecting the qualities of bodies surround- 
ing or placed in contact with the cutaneous surface. When inflammation, 
or some other lesion takes place in the meninges of the brain, or in the organ 
itself, then the members become sometimes tremulous, and the extremities of 
the fingers lose their natural sensibility. The attention no longer directs the 
application of the organs of touch, and the memory is unfaithful. Hence 
spring illusions from the tactile impressions of bodies. These patients are 
awkward, grasp feebly, and do not retain what they lay hold of They break, 
or permit to fall, the objects they have taken up. They judge incorrectly of 
the form, extent, solidity and weight of bodies ; the pathological condition of 
the brain not permitting them to rectify these illusions. 

A lady very much enfeebled by her confinement, and by sanguine evacua- 
tions, performed in order to combat an attack of mania, suffered from obsti- 
nate constipation. I prescribed enemata ; and notwithstanding her agitation, 
she wished to administer them herself Scarcely had they put the syringe into 
her hands, than she threw it aside with horror. The same thing is repeated 
several times. This lady has since assured me, that the syringe appeared to 
her so heavy, that she thought it was filled with mercury, and persuaded her- 
self, that we wished to make a barometer of her body. 

Conclusion. — From what precedes, I think we may conclude : 

1. That illusions are produced by external and internal sensations. 

2. That illusions are the result of the action of the sentient extremities, 
and the reaction of the nervous centre. 

3. That illusions are as often provoked by excitement of the internal, as by 
that of the external senses. 

4. That illusions should not be confounded with hallucinations, (visions), 
since in the latter the brain alone is excited. 

5. That illusions mislead the judgment respecting the nature and cause of 
the impressions actually received, and impel the insane to the commission of 
acts, dangerous to themselves and to others. 

C. That the sex, education, profession and habits, by modifying the cere- 
bral reaction, modify the character of the illusions. 

7. That the illusions take the character of the passions and ideas which 
control the insane. 

8. That reason dissipates the illusions of a man sound in mind, whilst it is 
impotent in destroying the illusions of the insane. 

This essay will not be without interest, if, by observation, I have proved the 
existence of a psychological phenomenon imperfectly understood, although 
frequent in delirium ; if the facts which I have related, throw some light upon 
the history, still obscure, of the aberrations of the understanding ; and if 
these facts furnish therapeutic views, applicable to the treatment of mental 
diseases. 

[The general principles of treatment both in Illusions and Hallucinations, are the 
same. Active remedies are rarely necessary. Abundant exercise in the open air, a nu- 
tritious diet easy of digestion, the warm bath, and counter irritation in many cases, to- 
gether with cheerful, and if possible engrossing occupations, will meet most successfully 
the indications of treatment. Great tact and ingenuity, as well as promptitude in deci- 
sion and action, are often necessary in the management of those suffering from this form 
of insanity, nor can detailed directions be given, which, in all respects will be adapted 
to the circumstances of any two cases. Still the leading principles of treatment being 
fully understood, a discerning mind will find little difficulty in their application.] 



FURY. 



Definition. — Causes hemorrhages, convulsions, apoplexy and death. — Aspect of counte- 
nance in a state of fury. — Confounded with mania by the ancients. — Rage, definition 
of. — Fury appears in all forms of mental alienation, and even dementia. — Sanguine 
and bilious-nervous temperaments predispose to fury. — By what caused. — Not in gene- 
ral automatic. — Usually intermittent. — Fury sometimes terminates in dementia, and 
sometimes is the last link in the chain of circumstances that affect its cure. — Fury 
renders the prognosis in mental alienation more favorable than its opposite. — It may 
be so intense as to create danger. — Treatment, with important remarks. 

Fury is a violent excitement, caused by an error of mind or heart. We 
call that man furious, who, transported by delirium, or some passion, exhausts 
himself by talk, by threats and actions; seeking at the same time to injure 
others and himself. 

Fury expresses the highest degree of exaltation of the vehement passions. 
We love or hate with fury. We denominate fury, a violent attack of anger. 
Religious fanaticism as well as political excitement and enthusiasm, are some- 
times converted into uncomplicated fury. This extreme state of the passions, 
which deprives a man of reason, and conducts him to the most fearful resolu- 
tions, leads, often enough, to mental alienation. It causes hemorrhages, con- 
vulsions, apoplexy and death. In fury the face is flushed, or very pale, and 
always spasmodically aftected ; the eye flashes, the expression of the counte- 
nance is ferocious, the voice loud and hesitating, the tone threatening, and 
the whole body convulsively agitated. Fury is in most cases expansive, though 
. sometimes, sullen and concentrated. It is always succeeded by lassitude, and 
/ extreme prostration of the vital forces. 
Vf Fury is an accident, a symptom ; — it is the anger of delirium. It was con- 

X. founded with mania by the ancients, and by many moderns, just as hydropho- 
f bia was confounded with rage, which is an extreme degree of fury. Mania 
> consists in a general chronic delirium, without fever, with exaltation of the 
sensibility and motive powers, in opposition to dementia, which is a general 
chronic delirium with diminution of power. But all maniacs are not furious; 
nor are all those suffering from hydrophobia enraged. Fury however, appears 
in all forms of delirium, even in febrile delirium. It appears in all forms of 
mental alienation, and even in dementia. It bursts forth also in many diseases, 
which we cannot confound with mania, such as meningitis, hysteria and hy- 
drophobia. It appears in drunkenness, after the use of certain poisons, etc. 
Fury is therefore, a symptom, very distinct from mania. It may well appertain 
to a variety of mania, but not furnish it with a specific character ; since we 

16 



122 FURY. 

observe it in many varieties of monomania, lypemania, dementia and idiocy. 
The sanguine, and particularly the bilious-nervous temperament, both being 
exceedingly irritable, predispose to fury. The scorching heat of the air, cer- 
tain atmospheric constitutions, and certain winds, render more imminent the 
explosions of fury, as well as all those circumstances that augment the impulse 
of blood towards the head, or excite the cerebral nervous system. 

Fury is caused by the use, or rather the abu.se of various substances intro- 
duced into the stomach. Wine, alcoholic liquors, opium, etc., produce fury. 
The same is true of meningitis, hydrophobia and hysteria. In all these cases, 
the hallucinations, illusions of the senses, and the perversion of the moral 
affections which overthrow the reason, render the patient furious. If maniacs 
are more frequently furious than other insane persons, it must be attributed to 
their temperament, their extreme susceptibility, and the exaltation of all their 
faculties ; circumstances which render them exceedingly impressible, and con- 
sequently, very irritable and choleric. Man in a state of dementia is rarely 
furious, because innervation, in his case, is without energy, sensibility almost 
extinct, and impressions almost null. Fury is no more automatic than are all 
the other determinations of delirium, inasnmch as the furious do not give 
themselves up, without motive, to their transports of excitement. It is to 
shun some danger with which they believe themselves menaced, to resist ob- 
stacles real or imaginary, or in fine, to take vengeance upon those whom they 
regard as their enemies, that the insane become furious. I shall have to no- 
tice, however, some exceptions, in speaking of homicidal monomania.* 

Fury is rarely continued. It is intermittent, like the action of the causes 
that produce it. If continued, it cannot be of long duration. It is always a 
distressing symptom in fever, or in the phlegmasiae. It is not thus in mental 
alienation, and is critical in consecutive dementia. When, after a too debili- 
tating treatment, the insane have fallen into dementia, if they recover their 
vital forces, mania and even fury, put an end to the delirium. This was ob- 
served by Pinel, among the insane, who, after having been submitted to treat- 
ment at the Hotel Dieu, were sent to the Bicetre in profound dementia. We 
also see fury terminate in incurable dementia, and sometimes a single day suf- 
fices to produce this result. The fury which occasions so much terror and 
disquietude, among those who are not accustomed to the insane, far from ren- 
dering the prognosis in mental alienation less favorable, furnishes stronger 
hope of cure. Furious maniacs and monomaniacs, are cured more frequently 
than the insane who are composed and mild. With the latter, there is less 
vital force, less energy, less reaction, and cures are more difficult. It is not 
unusual, that after an attack of fury, the insane become more calm and ra- 
tional. But if the fury is continued, if the delirium is general, and so intense 
that it takes from the furious person the sentiment of his own existence, we 
may fear that the patient will not resist the excess of excitement, and that 
death will promptly supervene. If the insane in their fury, commit acts of 
atrocity, it is to be feared that they will not recover. (I have never seen an 
insane person cured who had taken the life of his children, relatives or 
friends.) They are not incurable however, when they have compromised 
only their own existence. 

[A female aged 24 years, was placed at the Retreat for the Insane at Hartford, Conn., 
during the autumn of 1840, who had just taken the life of one of her children, and made 
an attempt upon that of another. She was small, slender, and quite delicate. Her fea- 
tures were small — their expression vacant, yet tinged with melancholy. She refused to 
speak, and disregarded any request that was made. Such was her condition for several 
weeks. At the expiration of this period, I was informed one morning by her nurse, that 

* See note on Homicidal Monomania. 



FUKY. 123 

a change had taken place in Mrs. . On repairing to her apartment, I found her 

bathed in tears. The expression of her countenance was changed, and she seemed to 
have awoke to the realities of her condition. She replied in monosyllables to such 
questions as were put to her, but with manifest reluctance. 

Suffice it to say, that after a long and tedious convalescence, during which she suffer- 
ed greatly from palpitations of the heart and other nervous symptoms, she recovered per- 
fectly, and has continued well until the present time. This case may be found reported 
at some length in the Eighteenth Annual Report of the Retreat, Hartford.] 

Fury, being one of the most alarming symptoms of insanity, ought to at- 
tract particular attention, though it does not require spegial treatment. Its 
treatment should be merged in that of the maladies of which it is a symp- 
tom ; nevertheless, it requires special hygienic attentions. It is because fury 
has been taken for insanity itself, and great therapeutic importance has been 
attached to this symptom, that so many grave errors have been committed in 
the treatment of the furiously insane. They were bled to excess, with the 
intention of abating their vital force, and it was not perceived that the loss 
of blood augmented the evil, and that it composed the sick only by depriving 
them of the power of reaction, necessary for the solution of the disorder. 

This symptom has been the cause of the most general, as well as fatal 
errors in the treatment of the insane. Seeing among them only the furious, 
all the insane have been treated like dangerous and mischievous animals, ready 
to destroy and exterminate every thing ; against whom it was necessary to pro- 
tect society. Hence dungeons, cells, grates, chains and blows ; means which, 
by exasperating the delirium, were a principal obstacle to its cure. Ever 
since these unfortunate people have been treated with kindness, the number of 
the furious has diminished to such a degree that, in hospitals well kept, and 
properly arranged, among many hundred insane people, not one can be found 
in a state of fury. 



MENTAL ALIENATION 

OF THOSE RECENTLY CONFINED, AND OF NURSING WOMEN. 



Preliminary remarks. — Subject divided into two parts.— Pari First. — Temporary deliri- 
um of early confinement briefly noticed. — Nearly one twelfth of the women at the 
Salpetriere became insane after confinement. — More among the wealthy insane after 
confinement , among the poor after weaning. — History of this form of insanity. — Pe- 
riod of the first appearance of insanity in 92 cases, succeeded by several important 
deductions. — Symptoms accompanying an attack. — Form of insanity affecting 92 cases. 
— Age during which women are most subject to this malady. — Illustrative cases. — Is 
the suppression of the milk the cause or eff'ect of insanity .'' Does the milk act as a 
foreign body in those accidents which follow confinement or lactation ? Opinions of 
both ancients and moderns on these questions. — This class of cases generally cured, 
unless the predisposition is too energetic. — How produced. — Duration of attacks. — 
Relapses. — Mortality. — Remarks on post-mortem examinations. — General treatment. 
— Part Second. — Cases, with treatment in detail ; together with an account of certain 
post-mortem examinations. 

Although much has been written respecting the diseases to which those re- 
cently confined are exposed, and the ravages which the milk commits in the 
economy, when diverted from its secretory organs ; accoucheurs and physi- 
cians, who have treated of the diseases of women, have little to say re.specting 
those forms of mental alienation which burst forth after confinement, and 
during or after lactation. It is this circumstance which has determined me in 
making choice of this subject ; with the hope of spreading abroad some light 
in a department of practice, of the more importance, as it interests a great 
portion of the female sex. 

This essay is divided into two parts : the one is limited to considerations 
deduced from my private practice, and the division of the insane at the Sal- 
petriere : the other embraces observations or cases, which serve as a basis to 
the general considerations expressed in the first part. I had at first, distri- 
buted the observations in the first part, but it appeared to me, that they divert- 
ed the attention too much, and interrupted the chain of general ideas, which 
I have endeavored to render as brief as possible. 

PART FIRST. 

I will not speak of the transient delirium which takes place after confine- 
ment, and sometimes during the milk fever. This delirium is speedily dissi- 



126 MENTAL ALIENATION 

pated, either by the occurrence of the lochial discharge, or by its diminution 
when too abundant ; by the lacteal secretion, the cessation of the fever, or the 
return of strength. Mauriceau and other accoucheurs have witnessed delirium 
on the second day of confinement, and seen it disappear on the fourth. Neither 
will I speak of the delirium of those who, in their phrensy, destroy the chil- 
dren to whom they have just given birth. False shame, perplexity, fear, mise- 
ry and crime, do not always lead to infanticide. Delirium however, by dis- 
turbing the reason of the recently confined, sometimes also, directs their sac- 
rilegious hands. A maiden becomes pregnant, does not conceal the fact, and 
causes the linen proper for her confinement to be prepared, and announces the 
expected event to all. She is confined during the night. On the following day, 
she is found in her bed and the child in the privy ; mutilated by twenty-one 
wounds with an instrument, which is supposed to be a pair of scissors. She 
is arrested some hours after, and carried upon a litter, a distance of two 
leaorues from the house where she was confined. She endeavors to conceal 
herself from the gaze of her indignant country women. While on the way, 
rising with difficulty, she frequently says to those who bear and conduct her : 
" They will do me no harm; they will do nothing to me; will they? I have 
done no injury ; they can do nothing to me." Some days after she is interro- 
gated, and avows her crime ; does not defend herself, manifests not the least 
regret, but refuses to eat. Has not this young woman suffered from an attack 
of delirium ? Finally, this and other facts of similar import, belong to legal 
medicine, and ought not to occupy me here. 

The number of women who become insane after confinement, and during 
or after lactation, is much more considerable than is commonly supposed. In 
fact, at the Salpetriere, almost one twelfth of the women received, have be- 
come insane under these circumstances. There are years in which this pro- 
portion is one tenth ; thus, of eleven hundred and nineteen women admitted 
into the division of the insane, during the years 1811, 1812, 1813, and 1814, 
ninety-two became insane after confinement, during, or immediately after lac- 
tation ; and of these ninety-two women, sixty belonged to the years 1812 and 
1813, durinff which there were six hundred admissions. And if of the whole 
number of insane women received during these four years, we deduct at least 
one third, who have passed the age of fifty years, beyond which period, wo- 
men are not exposed to the influences of confinement and lactation, we shall 
be led to conclude, that mental alienation as a result of confinements, during, 
and after lactation, is more frequent than I at first intimated. This is true, 
particularly among the wealthy. The number in this class, according to the 
result of my private practice is almost one seventh. Astruc also, had observ- 
ed that deposits, and engorgements of milk, are more frequent among the 
higher than the lower classes of society. But it is certain also, that mental 
alienation after weaning, is rare among the rich, whilst it is frequent among 
the poor, who either from necessity or voluntarily wean their children. 

The precautions which the wealthy do, and are able to take, after weaning, 
account for this difference. Nothing can, however, relieve them of their ex- 
treme susceptibility, immediately after confinement, or whilst nursing. The 
epoch of the invasion of the malady, with reference to the time of delivery 
and lactation, it is not a matter of indifference to determine, since it fur- 
nishes indications useful in practice. Hippocrates, in the third book of Epi- 
demics, relates several cases of grave affections, attended with delirium, super- 
vening upon confinement, during the epidemic of which he gives the description. 
They are, for the most part, fevers. Perhaps case fourteenth, is one of acute 
mania. It is that of the wife of Epicrates, who, having been confined with 
twins, was delirious from the first day of confinement, and died phrenetic on 
the twenty-first. Levret informs us, that insanity is to be feared after confine- 
ment, if the lochia are scanty, or are suppressed ; especially if the breasts do 



OF THl RECKNTLY CONFINED. 127 

not fill, or fall away. Zimmennann,* mentions some examples of mania and 
melancholy, preceded by suppression of the lochia. He cites, among others, 
that of a woman, who was cured, only at the expiration of six months. There 
was published at Gottengen in 1745, a thesis, sustained by Doct. Berger, bear- 
ing the following title : De puerperarum Mania et Melancolid. I have never 
been able to procure it. Doublet! says, that the lacteal irritation, sometimes 
falls upon the brain, either immediately after confinement, or at the period of 
the lacteal revolution. Some who have been confined, adds this author, have 
a fixed pain in the head ; others are in a stupor, have a dull expression, and 
reason falsely. Of our ninety-two women, sixteen became insane, from the 
first, to the fourth day of confinement. We read in Puzos, | that lacteal 
deposits are sometimes made in the brain, and that they produce insanity by 
compressing this viscns, or rather, by distending its fibres. These deposits, 
according to this author, take place like others, from the tenth, to the twelfth 
day after confinement. He reports three cases on this subject. Among our 
ninety-two women, twenty-one became insane from the fifth, to the fifteenth 
day after confinement. Seventeen became insane between the fifteenth and 
sixtieth day after confinement, the extreme limit of the lochial discharge. 
Nineteen women lost their reason, between the second month or the following 
one. and the twelfth, durino- lactation. Nineteen were seized with mental 
alienation, immediately after a forced or voluntary weaning. We may there- 
fore conclude : 1, that alienation of mind, is not more frequent among the re- 
cently confined, than among nursing women : 2, that the danger of losing the 
reason, diminishes, in proportion as the female is removed from the epoch of 
confinement : 3, that nursing women, especially poor ones, are much more lia- 
ble to become insane after weaning, than during the period of lactation. 

Mental alienation after confinement, is sometimes announced by sinister pre- 
sentiments, even during pregnancy. Sadness and disquietudes, exaggerated 
or without foundation, are a prelude also, to the explosion of delirium. Some- 
times the irruption of insanity takes place suddenly. At first, this class of 
insane persons appear to be in a febrile state. The skin is warm, pliant and 
moist. It is also pale, the tongue white, the breasts flaccid ; and the abdomen 
neither tender nor painful. Sometimes, there is a very acute pain in the head 
or uterus, the pulse is small, feeble and concentrated, and at the same time, 
there is uncomplicated delirium or monomania, more frequently, mania, 
rarely dementia. Sometimes also, the most profound stupor presages phrensy, 
with which it is easy to confound mania. But the pain in the head, the red- 
ness of the eyes, the dryness of the skin, ringing in the ears, the anomalies 
of the pulse, subsultus tendinum, ataxy of the symptoms, and their rapid 
increase, furnish distinguishing evidence of the latter malady. Phrensy ter- 
minates fatally on the third or fourth day, rarely passing the seventh ; whilst 
the duration of mania after confinement, is prolonged, and persists for several 
weeks or months, and sometimes even more. Mental alienation which makes its 
appearance during, or after lactation, presents little difference, as it respects its 
character and progress, from insanity which breaks forth under any other cir- 
cumstances. Notwithstanding, there is something peculiar in its aspect, which 
causes it to be recognized by one who is accustomed to the care of the in- 
sane. 

In comparing the diff'erent forms of mental alienation of the nine-two wo- 
men who constitute the subject of this essay, I find the numbers following : 
Dementia - - - - - - -8 

Lypemania (melancholy) and monomania - - - 35 

Mania - - - - - - - 49 

* Treatise on Experience. 

t Memoirs of the Royal Society of Medicine, ann. 1786, t, viii. p. 179. 

t Memoir on Lacteal Deposits. 



128 



MENTAL ALIENATION 



It may perhaps be asked, if the recently confined and nurses never sink 
into idiocy ? By no means ; since idiocy is a cerebral alteration, appertain- 
ing to earliest infancy. 

Before passing to the causes which produce insanity among the newly con- 
fined and nurses, I ought to determine the age, during which they are most 
subject to this malady. Of our ninety-two women : 

22 are from 20 to 25 years of age. 

41 " 25 " 30 " 

16 " 30 " 35 " 

11 " 35 " 40 " 
2 " 43 " 

The age at which nursing women, as well as those recently confined, are 
most subject to mental alienation, is from 25 to 30 years. It is also the age 
of the greatest fruitful ness. The causes which especially predispose the re- 
cently confined and nurses to this malady are, hereditary predisposition, an 
extreme susceptibility, attacks of insanity anterior to pregnancy, and attacks 
consequent upon preceding confinements, or during lactation. In some cases, 
the predisposing causes suffice, not only to produce a transient delirium, but 
also to excite an actual attack of insanity. Such are the severe labor of con- 
finement ; and the return, simply, of confinement or lactation ; the same phy- 
sical circumstances bringing back the same functional alterations of the brain, 
together with the same intellectual, and moral disorders. It is singular, that 
women have been known to become insane after giving birth to a male child, 
while they were exempt from this accident after confinement with a daughter. 
We have seen women, whose delirium manifested itself only after every se- 
cond confinement ; also those who fell into the same condition, on the third 
or fifth month of each period of lactation, without any assignable exciting 
cause. The exciting causes which provoke insanity among the recently con- 
fined and nurses, are errors in resimen and the moral affections. Coolness ; 
the impression of cold, in whatever way it may be made, is of all errors, most 
to be dreaded. 

Exposure to cool air, or the application of cold water, by suppressing the 
lochia, provoke insanity ; — and this, whether the person in child-bed, exposes 
herself to currents of cold air, or walks abroad ; whether she, or her who 
nurses, plunges her limbs in cold water, cuts the hair, or employs in excess, 
heating remedies. Among our ninety-two insane women, fourteen times was 
mental alienation provoked by physical causes, and among these fourteen cases 
in ten instances, the impression of cold was the cause of the malady. Hasty 
weaning, whether voluntary or forced, becomes the cause of insanity, when 
nursing women, at this period, neglect those precautions which prudence and 
experience enjoin. We have already seen also, that nineteen, out of ninety- 
two women, became insane a few days or immediately after weaning, in con- 
sequence of imprudences or negligence. We have already remarked that in- 
sanity after weaning, is rare among the higher classes, because the women 
belonging to this class are extremely cautious at this period. 

Moral affections are the most frequent cause of mental alienation among 
those recently confined, and nursing women. They are to physical influences, 
in respect to frequency, as one to four. The fatal, as well as general in- 
fluence of these causes, has been understood in all times. At Rome, a crown 
was suspended over the entrance of the house of those recently confined, to 
give notice, that it was a sacred asylum. There exists at Harlem a law, 
which requires that a sign be placed upon the house of lying-in women. 
This sign serves as a safe-guard against the intrusion of bailiffs, and agents of 
police, who might otherwise present themselves in virtue of their office. Van- 



OF THE RECENTLY CONFINED. 129 

Swieteii assures us, that women in confinement, are often afflicted with incu- 
rable mania, in consequence of some corroding grief What happens in con- 
sequence of confinements occurs also, during and after lactation, but is attend- 
ed with much less danger. Of our ninety-two women, forty-six became in- 
sane, after suffering from some moral affection. The fear of again falling sick, 
after having had an attack of insanity, the despair caused by the loss of a 
child, or the abandonment of the father, anger, fright, mortification, and do- 
mestic dissensions, are also exciting causes. 

The effects of fright were remarkable during the year 1814, since, of thir- 
teen women who had become insane after confinement, in consequence of 
moral affections, and who were admitted into our hospital during that year, 
(1814), eleven became insane in consequence of fright. I made the same 
observation in eighteen hundred and fifteen. The predisposing prepare the 
recently confined, and those vvho are nursing, in some sort, for the action of 
exciting causes. Both the one and the other act with the more energy, in 
proportion as confinement and lactation, exalt the susceptibility and mobi- 
lity of lying-in and nursing women, and render them more accessible to acci- 
dental influences. These latter, and among them, especially moral affections, 
are the more fatal, in proportion to the promptness with which they act. 

A lady is happily confined, and on the following day perfumes her bed with 
odoriferous fluids. The lochia are suppressed, and the milk is not secreted. 
Mania bursts forth on the same day, and she is cured only at the expiration of 
ten months, after a catarrhal fever. A husband throws a bucket of water 
upon his wife, who was confined the night before. The unfortunate woman 
immediately becomes a maniac, and never recovers. A young woman eighteen 
years of age, evades the watchfulness of her parents, dissembles her pregnan- 
cy, is confined in a garret, at a very cold season, and passes down the stairs 
in order to regain her chamber. The lochia are suppressed, and an irruption 
of mania takes place, from which she recovers at the end of a year, when the 
menses are reestablished. A woman, while nursing, is overtaken by a .storm. 
She had become warm by walking rapidly, and passes through a stream, the 
water of which reaches her knees. The milk ceases to flow, and she be- 
comes a lypemaniac. Another is frightened by a thunder-clap. The milk is 
suppressed, and she loses her reason. 

When physical or moral causes, isolated or united, exert their action upon 
the recently confined, the lochia are diminished or disappear, — the milk no 
longer comes to the breasts, or they become flaccid, and mental alienation 
breaks forth. Things do not always proceed thus. It happens that insanity 
manifests itself, although there be no suppression; though the lochia flow im- 
perfectly and scantily. There are cases, though they must be admitted to be 
very rare, in which the lochial discharge is natural, and partakes even of a 
hemorrhagic character, (case first), and nevertheless, the reason of the patient 
wanders. The same is true of the milk. Now it is wholly suppressed ; and 
now there is not suppression, but the secretion is less abundant. It does not 
possess its nutritive qualities, and the child refuses the breast. Moreover, 
mental alienation occurs, although no suppression nor diminution may have 
taken place, and lactation continues, suited to the wants of the child. Here 
are very naturally presented, two interesting questions, which for a long time 
furnished matter for debate. 

1. Is the suppression or diminution of the milk, the cause or effect of men- 
tal alienation ? 

We may reply, that insanity manifests itself most frequently, among women 
who do not nurse. Of our ninety-two insane women, twenty-nine were single, 
and sixty-three married. Now single women rarely nurse. The greatest num- 
ber of facts, prove, that the milk diminishes, is suppressed, or loses its dis- 
tinctive qualities, before the explosion of delirium ; but there are observations 

17 



130 MENTAL ALIENATION 

also, which furnish undeniable proof, that the suppression or diminution of 
milk, takes place only after the explosion of insanity. 

2. Does the milk act as a foreign body, in those accidents which follow con- 
finement or lactation 1 

The ancients believed, that the milk was conveyed to the brain, just as they 
thought that it was sent to other organs ; and attributed to metastasis, all the 
accidents which followed its diminution or suppression. Sennert believed, 
that the delirium, under these circumstances, is the effect of the vapors, which 
pass from the uterus to the head. Levret assures us, that milk has been found 
within the cranium. Boerhaave opposed the treatment of the different patho- 
logical phenomena which appear after confinement, as different maladies; 
but rather as the same malady, appertaining to the same cause, and conse- 
quently identical, but manifesting itself under various forms. Almost all ac- 
coucheurs have attributed the different accidents which follow confinement 
and nursing, to lacteal metastasis. This opinion is popular, and consoles some 
unfortunate people for the ills, from which there is no release. Nevertheless, 
the experiments of the moderns, particularly those of Chaussier and Bichat, 
demonstrate that no milk is to be found in the abdomen of those recently 
confined, who have died of peritonitis. Nor does it exist in the cranial cavity 
of those who have died insane after confinement. 

The moderns believe with reason, that after confinement, and during lacta- 
tion, there exists a lacteal diathesis, which modifies all the secretions of the 
female, and impresses upon them its own character ; that the susceptibility of 
the recently confined and of nursing women renders them more dependent 
upon external infiuences ; that these influences act upon this or that organ, 
and cause the development of accidents which characterize the diseases pro- 
per to these organs ; accidents, which are modified by the general diathesis, 
that is, the lacteal. Hippocrates, (book v, aph. 40,) says that women whose 
blood escapes by the nipples, are threatened with mania. However, we see 
women, who experience a diversion of the menstrual secretion to the nipples, 
without any other accident. Planchon assures us, that Doctor Pieters of 
Louvain, had seen a nursing woman, who passed blood instead of milk by the 
nipples, and who did not become insane. Doublet has many times observed 
at the hospital of Vaugirard, nursing women whose engorged breasts discharg- 
ed blood, without any serious results. 

Mental alienation, following confinement, is generally cured, if the predis- 
position is not too energetic. More than one half are restored. Among our 
ninety-two women, fifty-five were cured ; constituting one seventh of the total 
number of cures obtained at the Salpetriere, during the four years referred to 
above. The mental alienation of this class, is terminated by the reestablish- 
ment of the lochia, by the secretion and evacuation of milk, by an abundant 
leucorrhoea, by mucous and sometimes sanguinolent alvine dejections, by the 
return of the menses that have been suppressed ever since the beginning 
of pregnancy, and by subcutaneous suppurations ; very rarely by pregnancy. 
The duration of the attacks is variable. Of fifty-five cures, 

4 took place during the 1st month ; 
7 " " 2d 

6 
7 
5 
9 

15 during the following months ; 
2 after two years. 

Therefore, thirty-eight, or rather two thirds of the cures, took place within 
the first six months after the attack of mental alienation. 



(( 


(t 


3d 


<( 


It 


a 


4th 


(I 


f( 


(( 


5th 


(( 


(< 


(( 


fith 


i< 



OF THE RECENTLY CONFINED. 131 

If the cures of the recently confined are frequent, we must admit that these 
patients are disposed to relapses, when a strong predisposition has preceded 
the first attack. We may prevent this disposition to periodicity, by avoiding 
the circumstances which, having produced the first, may occasion the return 
of new attacks of insanity. They are prevented by avoiding pregnancy. 

I was not a little surprised, whilst arranging the notes which I have made 
respecting our ninety-two women, to find but six deaths. 

1 after six months from confinement ; 

1 after a year ; 

2 after eighteen months : 
1 after three years ; 

1 afl;er five years ; 

Therefore, the mortality is only one eighteenth, among women, insane in 
consequence of confinement, during, or after lactation. It is only one fifty- 
third, with respect to the mortality of the whole division of the insane con- 
nected with our hospital. How happens it, that the abdominal affections 
Avhich occur after confinement, are so often mortal, whilst the cerebral mala- 
dies, which take place at the same period rarely prove fatal ? This sketch is 
not perhaps useless, with respect to the physiology of the brain, and the ap- 
preciation of the influence of this organ upon organic life. The opening of 
the bodies of those who have been confined or nursed, and have died after 
having been insane a longer or shorter period of time, offers, strictly speaking, 
nothing in particular ; nothing which enables us to recognize the material 
cause of this form of alienation, or to discover its seat. Selle, in his collec- 
tion of observations, states that he found, poured out into the brain, a great 
quantity of pus, in the case of a woman who had died after a second confine- 
ment, and had suffered from an attack of mania, in consequence of a preced- 
ing one. I found serum amono- the folds of the arachnoid membrane, as in 
other cases of insanity, but never any thing that resembled milk. These are 
the albuminous effusions, which have been mistaken by some authors. 

Finally, it would be as strange to find milk in the brain after confinement 
or lactation, when there was suppression of this secretion, as to find menstrual 
blood in the cavity of the cranium, in females who have become insane after 
the suppression of the menses. When insanity is complicated with puerperal 
peritonitis, we find effusions, and false membranes, in the peritoneal cavity. 
The treatment of mental alienation, which occurs as a consequence of confine- 
ments, during or after lactation, has undergone many changes. Most authors, 
frightened undoubtedly by the violence of the symptoms which these cases 
present, have regarded them as incurable. Puzos admits that he partook of 
this error, after several fruitless efforts to overcome it. However, he at length 
persuaded himself, that by the use of powerful evacuations, both by bleeding 
and purging, we could change this disordered condition of the brain ; but that 
the greatest efforts of art, were for a long time necessary. Deceived by the 
gravity of the symptoms, practitioners have, almost always, carried to excess, 
the means which they employed. They bled to the utmost, and suppression 
of the lochia fortified them in the belief of the correctness of the practice. 
Yet a too copious lochial discharge causes insanity. Haller states, that a wo- 
man was deprived of the faculty of thought, in consequence of a too abundant 
lochial discharge. 

I relate, in the second part of this memoir, a case of mania, which occurred 
in the person of one recently confined, who had had a uterine hemorrhage, 
for eight days. Boerhaave and Van-Swieten* inform us, that blood-letting 

* Comm. in H. Boerhaave Aphorismos, Paris, 1769, aph. 1332. 



132 MENTAL ALIENATION 

ought not to be employed, except in case of the utmost necessity, not even 
when the lochia are suppressed. By debilitating, say these authors, blood- 
letting injures, rather than benefits the patients. Without doubt, this is the 
result of the indirect force. The lassitude and exhaustion which follow con- 
finement, should have caused them to beware of appearances. They were in 
the habit of prescribing for a time, the most energetic purgatives, drastics 
and neutral salts. At a later period, they preferred the milder purgatives. 
In cases attended with suppression of the milk, they endeavored to bring it 
back to the breasts, by the application of cupping glasses, and by suction, or else 
they purged. If the disorder proved rebellious, they recommend a new preg- 
nancy and nursing, and because it has sometimes happened that this advice 
has proved useful, they have made of it a general precept. I am confident 
that it succeeds, only when alienation is accidental, and does not depend upon 
a serious prior, or predisposing cause. Bleedings ought to be employed cau- 
tiously during the first stage. When the sanguine temperament predominates, 
and there are signs of plethora or congestion of the brain, leeches to the vulva 
or thighs, are useful. The cups, vesicatories and sinapisms, applied, now to 
the legs or thighs, and now to the neck, in connection with a ptisan slightly 
sudorific or purgative, following the tendency of nature, will be preferred to 
means called heroic. 

Some persons recently confined, have been cured by the employment of 
purgative enemata. I have prescribed with success, immediately after con- 
finement, enemata, prepared with four ounces of sugar, and a sufficient quan- 
tity of milk. I recommended three of them a day, the patients observing, at 
the same time, a strict regimen in every respect. An emetic, repeated several 
times in succession, has also been success-ful among subjects remarkably lym- 
phatic. It sometimes happens, that vesicatories, which have not succeeded at 
the commencement of the malady, and during its period of irritation, produce 
the best effects, when renewed, sometime after the invasion of the disorder. 
Tepid baths, especially the hip-bath, and sometimes hot baths, second won- 
derfully the other curative means, when the patient has passed to the chronic 
state. Cool or cold baths are dangerous. When the malady persists, especial- 
ly among nursing women, if the menses are not reestablished alter the use of 
evacuants, we shall find advantage from applying leeches to the vulva, and 
cupping-glasses to the thighs ; employing emmenagogues, and other reme- 
dies, suited to recall the menstrual tlux. 

It is unnecessary to remark, that women who have become insane in 
consequence of confinement and lactation, ought to be submitted to the same 
creneral principles of treatment, with other insane persons ; that isolation, the 
aids of hygiene, and moral means, ought not to be neglected, and that these 
alone have sufficed to effect a cure, although more rarely, than in other forms 
of mental alienation. 

PART SECOND. 

Case I. — P. Y. E , fifty-three years of age, belongs to a family, many 

of which are insane. One of her cousins became insane in consequence of 

her confinement. E begins to menstruate at the age of sixteen without 

accident. Soon after, she grows tall rapidly, and at each menstrual period 
experiences colic pains. Her disposition is mild, yielding and diffident, and 
she resides in the country. 

Married at twenty years of age, she becomes the mother of five chil- 
dren. On the fourth month of the fifth pregnancy, she is frightened by a man 
who runs through the street with a drawn sabre. From this time she has pre- 
sentiments. She fears that her confinement will not be fortunate, and is per- 
suaded that she shall become insane. 



OF THERECENTLY CONFINED. 133 

Thirty years of age: she is happily confined on the 15th of April, 1811. 
Three days subsequently, she is seized with uterine hemorrhage, which occa- 
sions fears for her life, and ceases only at the expiration of eight days At 

this time, E is active, and excited, but free from delirium. A tonic reai- 

men is prescribed, and the secretion of milk takes place. She nurses her 
infant, but on the twenty-ninth day becomes delirious, commits a thousand 
extravagances, and wishes to destroy herself She strikes and abuses those 
about her, and for fifteen days, obstinately refuses to eat or to drink. On the 
forty-fourth day after her confinement, vesicatories to the limbs and a full diet 
are prescribed. She continues to nurse her child, although she has little milk. 
Sixtieth day. The milk has become abundant, and the patient eats well ; 
nevertheless mania continues. Some days after, she is brought to the Salpe- 
triere, July 25th, 1811. She is sad, and does not speak. The abdomen is 
distended. The infant is removed, and on the following day there is fury. 

July 27th. A laxative drink is prescribed, a vesicatory to the neck, and 
camphorated liniment is applied to the breasts, which are distended with milk. 
A whitish mucous discharge takes place from the vulva, the vesicatory dis- 
charges very abundantly, and the alvine evacuations are free. 

Aug. 20th. The vesicatory has ceased discharging, and the patient speaks 
and walks more readily. She eats little, digestion is easy, and the breasts no 
longer contain milk. 

Sept. 6th. She is better, although sad. She replies correctly, labors, and 
we consider her convalescent. 

Oct. 1st. She is profoundly melancholy, refuses to speak, to take nourish- 
ment, or to e.xercise. 

Oct. 3d. A vesicatory is applied between the shoulders, and followed by a 
febrile movement, which persists for fifteen days. 

19th. Cessation of the febrile symptoms. During the continuance of the 
fever, there is a progressive return of reason. 

22d. Her health is improved, and is so understood by the patient, who 
speaks without repugnance, and gives an account of what she has experienced. 
{A laxative drink). 

Nov. 10th. E has seen her relatives, and appeared very well at the in- 
terview. There is a return of vital energy, and a moderately full habit of 
body. ( Tepid baths, and aromatic drinks). The menses return. 

December. Vesicatory ceases to discharge, and convalescence is confirmed. 

Dec. 10th. This woman is discharged eight months after her confinement, 
seven after the invasion of the delirium, and four and a half after her admis- 
sion into the hospital. 

Case II. — T. J. M» , fifty-one years of age, is admitted at the Salpetri- 

ere June 30th, 1812. She has a sister who, after her confinement, became 
insane, and still remains deaf. Our patient is tall, having chestnut colored 
hair mingled with white. Her eyes are large and dark, face flushed, skin 
brown, physiognomy changeful, abdomen voluminous. When a year old, she 
had variola. At ten years of age, she had a severe illness, during which, a 
uterine hemorrhage took place. Eleven years of age, menstruation abundant, 
and followed by colic pains after each menstrual period. In youth her health is 
feeble, and she suffers from hemicrania of the left side, which persists for 
twenty-four hours. She is afflicted also, with epigastraloria. 

Twenty-five years of age. M. marries, and is better since her marriage, at 
least in appearance. Twenty-six.' First confinement. Mania and fury, which 
persist up to the period of the second pregnancy. Her second confinement 
terminated happily. Since that period, she has been confined twelve times, 
her confinements in each instance being laborious, and followed by mental 
alienation of a month or six weeks' duration. Thirty-nine. Apoplexy, follow- 



134 MENTAL ALIENATION 

ed by hemiplegia. Forty-seven years. After a severe fever, she suffered from 
mania and fury, which lasted for five months, since which she has had irre- 
aularities of menstruation, and cephalalgia. A cessation of the menses takes 
place at the age of forty-nine, without accident. Fifty years. A grave attack 
of fever occurs, followed by a return of the menses, which recur at intervals 
of a month, for the space of a year. Fifty-one years. M. loses her husband 
and is imprisoned. She is immediately seized with mania. When brought 
to the hospital, June 30th, 1812, she is in a state of mania. There is general 
delirium, agitation, and at intervals, panic terrors, tears, constipation, etc. 
Auo-. 12th, 1812. She is calm, knows her condition, weeps in view of her 
situation, and the loss of her husband. She reasons justly, but her mind is 
feeble. December, M. is well. The menses, which ceased at the first of the 
previous month, did not again appear. At the time of leaving the hospital 
she was unusually timid, but enjoying the perfect use of her reason. 

Case III. — S. J., forty years of age, was admitted at the Salpetriere April 
22d, 1812. She is tall, her face covered with pimples, her hair is chestnut 
colored, her eyes of the same color and lively, and her complexion light. She 
is of a moderately full habit. Twelve years of age, she has cephalalgia and 
nasal hemorrhages. Thirteen years of age. The menses first appear, suc- 
ceeded by a cessation of the hemorrhages. Since that period, her menses 
have been regular, but scanty. Eighteen years of age. The benefactor of 
this woman is beheaded. She is immediately seized with a general tremor, 
and her mind wanders for some days. Twenty-six years of age. J. marries, 
and becomes the mother of three children, whom she nurses. Thirty years of 
awe. She is confined with her fourth child, nurses it, and weans it incautious- 
ly. Two days after, she is taken with general delirium, attended by a pre- 
dominance of religious ideas. She is brought to the hospital, from which she 
is discharged cured, after four months' treatment. Thirty-six. A new attack 
caused by the absence of her husband. She is admitted a second time, at 
the hospital, May 28th, 1810, from which she is discharged June 21st, 1811, 
at the end of thirteen months. Thirty-nine. Fifth confinement ; seven 
months after which, she weans her child. The day but one afterwards, she is 
seized with delirium, attended with imaginary fears. She is taken to a pri- 
vate hospital, where an eruption takes place over her whole body, which, at 
length occupies only the face. At the expiration of twenty months, this pa- 
tient is brought to the hospital, April 22d, 1812. She is sad, melancholy, 
and in despair. She has also religious terrors. May 24th, 1812. A dis- 
charge from the left ear. Since that period she is more rational, judges cor- 
rectly of her disease, eats and sleeps well. June. Tepid baths, pimples upon 
the face, eyelids red, vesicatory upon the arm. Frojii this period, conva- 
lescence. This woman was discharged, Aug. 11th, 1812, enjoying the use of 
her reason. All the attacks were announced by sadness, uneasiness, and in- 
aptitude for her ordinary occupations. By degrees, the mind became lost. 
During the attacks, she experienced a burning and confused state of the 
brain. 

Case IV. — D S. D., forty-one years of age, was admitted at the Salpe- 
triere, June 19th, 1812. She is of medium stature, her hair is of a chestnut 
color, her eyes blue, her complexion light, her physiognomy mobile, and her 
habit of body moderately full. This woman has an uncle and an aunt who 
are insane. She met with a fall upon her forehead, when nine years of age. 
Traces of the cicatrix are still distinct. When fourteen years of age she is 
aflSicted with Psora. Sixteen years of age. The menses appear, preceded 
by headache. They are both scanty and irregular. At twenty-six she mar- 
ries. The menses from this period are more abundant. Leucorrhoea also 



OF THE RECENTLY CONFINED. 135 

exists. The pain in the head is more severe. At the age of twenty-seven 
years, during her first pregnancy, she meets with domestic trials. Her hus- 
band having undergone an operation unknown to her, she is frightened, on 
being apprised of it. Her mind wanders, and she becomes furious. She is 
now thirty-three years of age. She is treated at Charenton, and the attack 
lasts five months, the understanding remaining slightly enfeebled. She is 
again confined at thirty-five years of age. At the age of thirty-seven years, 
on the third day of her third confinement, slight opposition was followed by 
delirium and fury. Six days after, she was admitted at the hospital, from 
whence she was discharged at the expiration of ten months, the attack having 
lasted for six months. Forty-one years. Domestic troubles together with 
slight opposition, bring on a new attack of fury, which continues for a few- 
days. She was brought to the hospital June 19th, 1812, and after some days 
became calm, but irrational. Aug., 1812. She converses much, and for a 
long time ; she relates all that she ever knew, saw or heard, and with great 
incoherence, both of ideas and language. She enjoys, however, long intervals 
of reason. October. She is calm and labors, but is, at brief intervals, irra- 
tional. December. This third attack terminates in dementia. 

Case V. — L , the offspring of an insane mother (her daughter is in- 
sane, and her grand-daughter died a maniac), is of medium stature, her hair 
of a chestnut color, her eyes and skin brown, and her physiognomy mobile. 
At the age of fourteen or fifteen years, the menses merely make their appear- 
ance, and are suppressed for a year afterwards, with chlorosis and fever. At 
the age of sixteen years the menses return, since which, she has had thirteen 
children. At the age of twenty-three years, she first becomes a mother. 
From that period, the menstrual flow is irregular and scanty. Twenty-nine 
years. Her infant having died some days after her fourth confinement, she 
becomes a maniac from excessive grief. She is treated at the Hotel-Dieu. 
The menses are suppressed for a year, and a cure takes place after eighteen 
months. Since this period, at each confinement, immediately after the secre- 
tion of milk takes place, she is seized with mania : now, with suppression of 
the lochia and menses ; now without suppression. The attacks last, usually, 
one year. Each attack is announced by abdominal pains, which extend to the 
uterus, and are attended with the sensation of a foreign body resting upon the 
rectum. The attack makes its irruption by cries and convulsions. 

At length, the fear of becoming insane produces delirium. She becomes 
agitated, and cannot refrain from speaking and walking about. A thousand 
hallucinations augment her delirium. She hears persons speaking whom she 
does not behold, and sees .strange objects which frighten her. She suffers 
from insomnia, palpitations and constipation. During the attack, she no lon- 
ger suffers from leucorrhoea, and the oz^na is not observable. Forty-five 
years. Last confinement. Attack mora violent than the preceding ones. 
Forty-nine years. She now suffers from flatulence, which painfully distends 
the abdomen, and embarrasses the respiration, especially when she has eaten. 
She then suffers more than at any other period. About the age of fifty years, 
the menses cease flowing, without an outbreak of delirium. Fifty-three years 
of age. Her husband joins the army, and she has a new attack. She suffers 
from winds that stifle her, and which ascend to her head. Then reason wan- 
ders, and she has a thousand hallucinations of hearing and sight. She has, 
also, convulsions. The paroxysms are renewed, ordinarily, every two days, 
and are announced, like the attacks, by cries. This state persists for six 
months. Since this attack, she has enjoyed her reason perfectly, but in spring 
and autumn, experiences, for some days, a convulsive trembling of the limbs. 

At the age of fifty-nine years, Dec. 1811, she is severely frightened. Nine 
days subsequently, she is suddenly seized with abdominal pains, extending to 



136 MENTAL ALIENATION 

the uterus, and convulsions ; terror, delirium, a desire to walk about and to 
run. Hallucinations are present. She is aware of her condition, and de- 
mands that she be conducted to the Salpetriere. Admitted at the Hotel-Dieu, 
every thing appears changed, and in the utmost confusion. She hears one 
utter a cry, on seeing a surgeon making a vaginal examination and displaying 
his hand tinged with blood. L. believes that she every where beholds intes- 
tines floating about, and the smoking of blood. She is in the greatest fright, 
nor can she dissipate these phantoms, although she knows that she is deceived. 
Foot-baths are administered, and she is bled from the arm. All the symptoms 
are aggravated, and her delirium no longer permits her to recognize any thing. 
Her intelligence is overturned, and she has no longer a sense of her delirium. 
After two months, she is brought to the Salpetriere. March 25th, 1812. The 
abdomen is distended, habit of body moderately full, skin brown, physiogno- 
my mobile, and expressive of fear. There is delirium, constant desire to 
move about, constipation, and sometimes convulsions, particularly during the 
night. We bathe the patient, and administer cooling drinks. She gradually 
becomes calm. In July and Aug. she becomes tranquil, walks about less, 
and labors a little while at a time. September. The patient awakes to a 
consciousness of her condition, and feels herself sufficiently strong, to dissi- 
pate her hallucinations and vain fears. Moreover, she is very calm, and. rea- 
sons correctly. On the 12th Sept. 1812, she leaves the hospital well ; cured 
of her eleventh attack of mania. Since that period, she has fallen into de- 
mentia, attended with trembling of the limbs. 

Case VT. — R., thirty-four years of age, was admitted at the hospital, Nov. 
10th, 1813. She has a mild, but lively disposition. She is tall, with chestnut 
colored hair, large hazel eyes, a dark complexion, a mobile physiognomy, and 
a tolerably full habit of body. At si.xteen years of age the menses are spon- 
taneously established, and at the age of twenty-four, she marries. Twenty- 
six years. On the third day after her first confinement, a lady, having musk 
about her person, calls upon her. She is immediately seized with delirium, 
but continues, nevertheless, to nurse her child, who dies at the age of three 
years. This first attack was characterized by mania with fury, and last- 
ed but two months. It ceased suddenly, after a severe fright. Since the 
first attack, she has remained exceedingly susceptible. Every spring she has 
excitement without delirium, which is dissipated by the use of antispasmodics. 
Thirty years. Whilst weaning her child, aged one year, she descends to the 
shop of her husband, in which there was some paint. The odor immediately 
excites delirium, which increases for five days, and is followed by mania with 
fury. Aug. 4th, 1809, she was admitted at the Salpetriere. September. A 
very marked remission. R. is calm, and appears rational. Her husband 
solicits her discharge, and obtains it on the 12th of Oct. following. From 
the second day of her discharge, there is a return of the delirium and fury, 
accompanied with a suppression of the menses, and a distended abdomen. 
Readmitted at the hospital, the patient becomes calm at the approach of win- 
ter. In December, the menses are established, and R. is discharged June 
24th, 1811. Thirty-four years. Nov. 1st, 1813. An abortion at two months, 
attended with colic pains, uterine hemorrhage, and from the following day 
with loquacity. Nov. 3d. Mania and fury (tepid baths and leeches to the 
malleoU), without remission. The patient is brought again to the hospital. 
At her arrival, her eyes are haggard, face pale, features of the countenance 
shnniken, general delirium, mania, fury. Three days after, she is calm, and 
becomes aware that she is in the hospital. 16th. Menses are wanting. 22d. 
Patient sees her husband with satisfaction. She is sad, but her replies are cor- 
rect. [Tepid baths). 28th. Fever, attended with gastric embarrassment. 
{Emetic, repeated twice). Abundant dejections, since which her ideas are 



OF THE RECENTLY CONFINED. 137 

connected. She is calm, and labors. Return to reason progressive. Dec. 
21st. R. leaves the hospital, perfectly restored to the use of her reason, al- 
though the menses are not reestablished. 

Case VII. — M., (admitted at the Salpetriere April 29th, 1814, at the age 
of twenty-four years), was the offspring of a mother who died insane. She is 
tall, with chestnut colored hair, and an expressive eye. Her complexion is 
sallow, skin brown, physiognomy mobile, and her disposition gay. She has 
fits of anger, which are dissipated by tears ; is indolent and of great suscepti- 
bility. From infancy, she has been subject to ophthalmia, and has suffered 
from headache during her whole life. Six years of age. Psora and frequent 
nasal hemorrhages. When eleven years old, she has the small pox in its se- 
verest form. She is affected with ozaena, and the nasal hemorrhages have 
ceased. Fifteen years of age. The menses appear spontaneously ; since 
which period her health has been good, and the ozsena has disappeared. At 
each menstrual epoch, sometimes before, and sometimes after it, she suffers from 
headache, which is dissipated by vomiting. This woman marries at the age 
of twenty-three years. At twenty-four, being pregnant, she meets with a fall, 
and sprains one of her feet. At the fifth month of her pregnancy, the events 
caused by the approach of the allied armies, give her great uneasiness, and 
the more, as she is unable to walk, and remains at home alone. At the ninth 
month of her pregnancy, a Cosack threatens her life. She loses her appetite, 
and suffers from nervous twitchings. April 21st. On the eve of her confine- 
ment, she is frightened anew. 22d. She is confined, and has convulsions for 
twenty-four hours. 23d. Continuation of the convulsions. At their cessa- 
tion, she laughs continually, and is delirious. 24th. General delirium, agi- 
tation, fury, — refuses to take nourishment. The patient is unwilling to drink 
any thing but cold water. Symptoms are exasperated during the night. Ne- 
vertheless, the lochia continue to flow, though the secretion of milk does not 
take place. {Sinapisms to the feet). The pain caused by the sinapisms, caus- 
es the patient to believe that we wish to burn her feet. During her convul- 
sions, she bites her tongue, and the pains which result from it, seem to her to 
be caused by fire. 

She is brought to the hospital April 29th. On her admission, her complex- 
ion is sallow and discolored, her eyes constantly in motion, tongue white, 
breasts flaccid, and her delirium gay. The patient recognizes neither the per- 
sons nor objects that surround her. She considers herself an empress, and is 
constantly affirming that her husband is Louis XVIII, and that all the furniture 
is of silver, or some other precious metal. She grants favors to every body. 
Her step is haughty, her tone imperious, and her ideas of grandeur predomi- 
nant, notwithstanding the most complete incoherence. Her actions present 
the same disorder, and a similar exaggeration. Appetite voracious. April 
30th. — ( Vesicatories to both limbs, and laxative drinks). Lochia, mingled with 
a whitish mucus. May 8th. Discharge of matters, at first white. She is 
more calm, though the -delirium preserves the same character. 12th. Con- 
tinuation of the lochia. [Same medicines). Vesicatory discharges freely, — 
dejections brownish, mingled with mucous matters. Less disorder of the 
ideas. 15th. She sees her husband, and recognizes him. It seemed to him, 
that for a moment she recollected herself, and, as it were, came out of a reve- 
ry. This period however, is very brief, and the delirium continues, but she 
no longer entertains ideas of grandeur. 22d. Cessation of the lochia, — the 
vesicatory dries up, — there is more connection in her ideas, and her compo- 
sure is perfect. The sight of her husband affords our patient pleasure. 24th. 
Convalescence. She renders a complete account of the motives of her 
actions during her delirium. The vesicatory has ceased to discharge. 25th. 

18 



138 MENTAL, ALIENATION 

She experiences a sensation as if stunned, which enfeebles both her body and 
mind. Aside from this, she is rational, and obtains her discharge. 

Case VIII — L forty-one years of age, is admitted into the hospital Nov. 
28th ^1811. At the age of eighteen, a fright suppresses her menses and she 
is melancholic for eighteen months; after which, she enjoys comfortable health, 
her menses being reestablished. She is confined at the age of thirty-six years 
After the fourth day, the mid-wife having left her, she becomes alarmed and 
is much chagrined. The milk is suppressed, she is unwilling to eat, and be- 
comes furious. Her tongue is paralized. The menses reappear at the expi- 
ration of two months, and the patient sinks into a profound melancholy, wish- 
in<T to remain constantly in bed. If she rises, she remains en chemise, without 
Clothincr She eats reluctantly, sometimes cries out, and becomes angry with- 
out cau°se, and when she is desired to change her linen, or to eat ; to lie down, 
or to rise up ; flies into a passion and strikes. Nothing can induce her to 
speak when she does not choose to. She sometimes comes to a sense ot her 
condition, and exceedingly regrets her extravagances. The menses have been 
at all times reaular and abundant ; constipation obstinate. At the time of her 
admission at the hospital, the melancholy having persisted for five years, her 
complexion was pale, her features shrunken, her hair and eyes black. She 
has also strabismus. She leaves her bed with great reluctance. She passes 
several days also without eating. Her hair, which had not been combed for 
five months, was tangled, as if matted and felted, and presented no traces of 
vermin nor their eggs. It was very clean, and a quantity amounting to fif- 
teen ounces, was cut off. Care was taken to cover the head with wool. Dec 
5th To-day apoplectic symptoms were present. {Sinajnsm, vesicatory, and 
a strengthening potioi^. 6th. She has spoken some words m a low tone^ 
There is prostration of the vital forces, and paralysis of the left limbs, with 
diminution of sensibility. 8th. ( Vcsicatories to the thighs). Dejections 
which have persisted for many days. The patient offers some appearance of 
reason {Arnica). 24th. Same state, obstinately refuses food. Jan. 12th 
181-'> ' Unnatural freedom of the bowels ceases. The patient refuses food 
for about eight days, or rather, takes but a few spoonfuls of sugared wme. 
The vital forces became progressively extinct, and death takes place, January 

"^^^Autop^V iwenty-four hours after death. Hair black; cranium hardened 
and unequally thick; median fine distorted ; vessels of the pia-mater inject- 
ed • brain soft ; white substance injected ; depression of the convolutions o 
the' brain, corresponding with the suture formed by the junction of the coronal 
and parietal bones of the right side, near the median line In this place, the 
nia-mater was much thickened, and contained serum. The lateral ventricles 
are contracted on every side ; their membrane adheres posteriorly to a great ex- 
tent, contains serum, and is injected, as well as the ch(>roid membrane. The 
heart is enlarged, flaccid and full of black blood. The liver is granulated 
and brown, and the gall bladder distended with bile of a deep brown color 
and very thick. The left extremity of the transverse colon has descended 
into the pelvic cavity. The omentum is very fat, the stomach very much re- 
tracted and interspersed with deep folds. The intestines also, are contracted 
in some parts, and the mucous membrane is red, brown, and sphacelated. 
We observe some fibro-cartilaginous parts in the proper membrane of the ute- 
rus, and the bladder is contracted, very much thickened, and its mucous mem- 
brane very red. 

Case IX —Those pupils who attended my clinical lectures on mental alien- 
ation,\aw at the Salpetriere, a young woman who was confined Sept. 25th, 



OF THE RECENTLY CONFINED. 139 

1818, and who experienced so serious a disappointment, at not having given 
birth to a boy, that she was taken with delirium on the first day of her con- 
finement, and became a maniac on the third. The delirium and fijry persist- 
ed fijr six weeks, aft;er which, she was alternately, calm and excited. This 
woman was brought to the hospital, Dec. 7th. On the 11th an enormous de- 
posit took place in the right groin. The delirium persisted, but the calm was 
perfect. The abscess opened spontaneously, towards the end of the month. 
The delirium immediately began to decrease. The patient began to conva- 
lesce Jan. 15th, and was restored to her family on the 8th Feb. following, four 
months and a half after her confinement 

Case X. — L., nineteen years of age, is happily confined Jan. 19th, 1819. 
She exposes herself to the cold air, and becomes delirious on the first day 
after confinement. The infant cannot nurse, because the nipple is not form- 
ed ; notwithstanding the milk is very abundant. The delirium increases. 
The patient strikes her breasts and is unwilling to be clothed. The third day 
the lochia are suppressed, and on the day following, leeches are applied to the 
vulva. Overcome by the heat, she rises from her bed, washes her hands, and 
drinks cool water. The delirium is violent, and the breasts very much dis- 
tended with milk. They apply leeches behind the ears, sinapisms to the feet, 
and prescribe an ethereal potion. One month after her confinement, this 
woman was brought to La Charite, from whence four days subsequently, she 
was transferred to the Salpetriere, March 1st, 1819. At the period of her 
admission, the patient presents the following symptoms ; face flushed, features 
shrunken, the breasts voluminous, resistent, and painful, — general delirium. 
She refuses to be clothed, has a feeling of fear, cries aloud, is abusive in her 
languaore, and suffers from nervous agitation. March loth, the right breast 
is enormously distended, the skin livid and violaceous, and fluctuation is per- 
ceptible. It is impossible to keep upon it the least covering. Some days 
after, the surgeon-in-chief of the hospital opens the abscess. From that mo- 
ment, the patient more readily admits the application of dressings. She is 
more composed, and is more attentive to what is passing around her. The 
delirium, however, persists, and suppuration is very abundant. At the begin- 
ning of the month of May, a laxative potion, continued for some days, pro- 
vokes copious dejections. ISth. Although there is still delirium, the patient 
sees her husband. From this time the progress towards reason was percepti- 
ble. The wounds cicatrize, which are successively formed, upon the right 
breast. We regarded her convalescence as confirmed from the 20th of the 
month of May, and on the 27th she was restored to her family, enjoying per- 
fectly the use of her reason, four months after her confinement. 

Case XI. — Mad'lle M., of medium height and nervous temperament, having 
black eyes, and a dark complexion, was still at that age when young people 
know of love, only by what they read of it in romances, when her mother ac- 
companied her to a ball. A voung man, with whom she was unac([uainted, 
pays his respects to her. She immediately experiences a singular and painful 
internal commotion. Some days afterwards, she experiences the same impres- 
sion. Notwithstanding, this young man is respectable, and unites in himself 
all those qualities that can flatter a young person, Vvhose affections are not 
already engaged. He speaks of marriage, but she experiences an insuperable 
aversion to this proposition, without being able to offer a reason for her repug- 
nance. Her parents insist, and she consents. But every time that she sees 
him to whom she is betrothed, she feels a painful internal sensation, whilst, 
during his absence, she believes she loves him, whose presence produces upon 
her an effect so strange. At length she marries. The first months of mar- 
ried life are the occasion of great suffering to her, without exciting any sus- 



140 MENTAL ALIENATION 

picion of the fact on the part of her husband. She loves him, yet his pre- 
sence makes her ill. She becomes the mother of two children, whom she 
nurses, and cares for, with the utmost maternal tenderness. She weaned the 
second, during the absence of her husband on a voyage. She becomes un- 
easy on account of his absence, and weans her child without the least precau- 
tion. From uneasiness, she passes to melancholy and sadness. Her friends 
desire to soothe her, and direct her mind to the consolations of religion. Her 
tender and devoted spirit imposes upon itself privations, and she offers prayers, 
which are prolonged into the night. She abandons her ordinary occupations, 
refuses every kind of exercise, and eats nothing. At length, delirium ap- 
pears. She looks upon her children without satisfaction. She is often 
tempted to destroy them, in order to preserve them from the extreme misfortune 
into which she believes they have been plunged by the abandonment of her hus- 
band. She has lost much flesh, and her complexion becomes sallow. There 
is loss of rest and constipation, but the menses recur at regular intervals. 

After six months' absence, she receives her husband with coldness. The 
lypemania increases. She many times recommends that they withdraw her 
children, and that they do not bring them to her without some special purpose. 
The voice of her children, or their noise in an adjoining room, produces a 
state of suffering and agony, which is clearly depicted upon her countenance. 
Her husband on one occasion, brings her children into her presence. She 
becomes pale, shudders, and comes near falling into a swoon. Another time, 
she pretends to embrace, with a view to stifle them. At the expirajion of a 
year, she is committed to my care. She is very much emaciated, has a sal- 
low tincre, and her eyes are fixed and convulsive, as well as the features of 
her countenance. The skin is dry and arid, and of a burning heat. The 
pulse is feeble and frequent. She refuses nourishment, and respiration is dif- 
ficult. She is sad, refusing all kinds of exercise, and every mode of diver- 
sion. She does not speak, but weeps much. She is often impatient when 
any one discourses with her respecting her condition, especially when offered 
any hope of a cure, which she regards as impossible. She demands to be 
shut up in a hospital, and takes all the remedies that are prescribed for her. 
After eight months of isolation, during which, nothing could withdraw the 
patient from her despair, nor cause a thought for her husband or children to 
spring up in her breast, after having exhausted means the most varied, I order 
a vesicatory to be applied to her left arm. Until this period, I had not thought 
its employment advisable, in consequence of the emaciation and irritability of 
the patient. On the following day, the vesicatory assumes an erysipelatous 
aspect. The arm swells, and discharges a thick and whitish fluid, very abun- 
dant and fcetid. At the end of a month, she is less sad, and less averse to 
consolations and diversions. On first seeing her husband, she seemed to be 
indifferent, but shortly manifested pleasure ; and was at length restored to her 
family, after an illness of two years. She hears her children spoken of with- 
out dread, but is still unwilling to see them, distrusting herself, she says. 
But she oversees her household affairs, goes into society, occupies herself, and 
continues to improve. It is not until the expiration of six months more, that 
she desires to have her children with her, and to direct their education ; — a 
duty, of which she acquits herself, with all the tenderness, that she had la- 
vished upon them previous to her illness. 

Case XH. — C. was born in the country, labored in the fields, and married 
a brutal husband. At twenty-six years of age, she becomes pregnant. She 
is attacked with psora, and her husband causes her every species of mortifica- 
tion. Nevertheless, she is confined ; but two hours thereafter is beaten and 
mal-treated by her husband, who throws a bucketful of cold water upon her 
body. The same day mania bursts forth, attended with fury. The lochia 



OF THE RECENTLY CONFINED. 141 

are suppressed, and the menses do not appear. All the means employed for 
the cure of this unhappy person prove fruitless. A maniac and furious for 
four years, she is at this time in a state of dementia. 

Case XIII.— Mad'lle B., twenty-five years of age, (descended from a father, 
subject to cephalalgia, which he was accustomed to relieve by the applica- 
tion of ice to the head), is endowed with a peculiarly nervous temperament, a 
crlowin<T imagination, and a lively and sensitive disposition. The culture of 
fetters and the arts, which constituted the basis of her education, by accord- 
ing with her native tendencies, contributed to the irregularity of her passions. 
At the acre of twenty-four years, she formed a prudential matrimonial connec- 
tion. Her husband entered the army. Mad'lle B. committed certain impro- 
prieties, and is severely censured by her relatives and friends. A young man, 
of an agreeable exterior, was prodigal of his attentions to her. She becomes 
enamored, and after a struggle of some weeks, deserts the house of her hus- 
band, and retires to that of her lover, where she experiences mortifications of 
every kind. She becomes pregnant. Her pregnancy is disturbed by disquiet- 
udes, by jealousy, by the desire to please her lover, by the fear of a severe ill- 
ness,' in fine, by the most painful regrets. Nevertheless her confinement is a 
happy one. ' On the day but one succeeding this event, she sprinkles her bed 
and chamber with odoriferous waters, and walks about on her naked feet, not- 
withstanding the cold. From the third day her actions were irrational. On 
the eighth, she has affectionate interviews with her lover. On the nmth, she 
overturns every thing in the house, and sports with her lover as if he were a 
child. Little milk is secreted for her infant. On the fourteenth day after her 
confinement, she is brought to a hospital, — a circumstance that makes a very 
stroncT impression upon her mind. Her reason is altogether lost. She de- 
stroys every thing, and becomes furious. The constant attentions which she 
pays her child, are more injurious than useful, both to the one and the other. 
She passes twenty-fours hours perfectly naked, concealed under a stair-case. 
On the twentieth day of her illness, March 11th, 1800, the patient is com- 
mitted to my care. Her countenance is pale, eyes haggard, the tone of her 
voice harsh and elevated, breath fetid, breasts flaccid, and her agitation con- 
tinual Her desires are strange. She is loquacious, makes obscene remarks, 
and has an irresistible propensity to tear. She is slightly warm and moist, 
and has no uneasiness respecting her child. 

On the twenty-first day after her confinement and sickness, she takes a bath, 
a purcrative enema, and a soothing drink. On the twenty-second day, she has 
a shiv^ering fit, agitation, hatred of certain persons, cries, complaints, an habi- 
tual state of opposition, painful reveries, fear, panic terrors, dread ot poison 
and of death. She has also, no connected ideas. On the twenty-third day, 
the child dies, without occasioning any grief on the part of the patient. 1 he 
lochia do not cease. On the twenty-eighth day, the menses appear and con- 
tinue until the thirty-third. Since then, there has been composure with sleep, 
but delirium. On the thirty-ninth day, there is a return of reason. Her lover 
visits her, and she is agitated from that day forward. On the forty-eighth day 
of the attack of the malady, she is composed, and is again visited by her lover. 
This is followed by agitation, and insomnia. The patient experiences the 
greatest excitement. The delirium is at its height. She converses with her 
lover though he is absent. She thinks he is in the walls, in her chamber, and 
even 'in her bed. Often, during the day, she takes the clouds for balloons, and 
calls aloud upon Garnerin the feronaut, to make with her a journey to the 
moon. She calls for her husband, father and mother,— tears every thing, and 
is often naked. She is loquacious, laughs loudly, and does not rest. During 
this period, she takes the whey of Weiss every day, which is followed by mo- 



142 MENTAL ALIENATION 

derate evacuations. On the sixty-first day her menses return again, but cease on 
the followiag day. On the sixty-seventh day, she takes a cold bath and douche. 
From the former she makes violent efforts to esca^je, and on leaving it, 
suffers from extreme prostration, a general trembling, and an enfeebled voice. 
A half-hour afterwards, the patient desires to leave her bed, and take food. 
The same treatment is continued until May third, when the bath is suspended, 
in consequence of the appearance of the menses. 

On the seventy-fourth day, May 10th, the menses cease. On the seventy- 
fifth day, there is composure, unmeaning gestures, and taciturnity. Seventy- 
sixth day, the tepid bath and douche. Seventy-seventh day, composure, sleep. 
Eightieth day, the douche again employed. She obstinately refuses to dress 
herself Eighty-second day, she enjoys some hours of reason. Eighty-third 
day, some stains of a hemorrhoidal flux. From the eighty-fourth to the nine- 
ty-fourth day, composure, but little sleep. On the ninety-sixth day of the dis- 
ease, June 2d, a hemorrhoidal flux. 3d. Agitation, extreme mobility, ob- 
scene discourse, cries, declamation. 5th. Douche repeated. 9th. Vora- 
cious appetite. 11th. Menses appear, during which, the patient is extremely 
agitated, is passionate, and contradicts every thing. 16th. Cessation of the 
menses. 19th. Tears ; she becomes conscious of her condition, and is desi- 
rous to be restored. 39th. Composure, tears, sleep. On the one hundred 
and twenty-fifth day, July 1st, she suffers from hysterical syncope. 4th. Calm, 
and rational ; nevertheless the patient destroys every thing within her reach, 
and abuses those who serve her. tJth. Progressive return of reason, hysteri- 
cal syncopes. Visit of her lover. 8th. Syncope; febrile movement, pre- 
ceded by rigors, l^th. Fever continued, presenting the symptoms of ca- 
tarrhal fever, with evening paroxysms, and frequent attacks of hysterical syn- 
copes, — progressive return of reason. 13th. Appearance of the menses, 
which flow abundantly, and cease on the 15th. Fever continues. Notwith- 
standing, the patient is not irrational, tears nothing, and eats moderately. We 
converse with her about her affairs, and her situation with respect to her hus- 
band- 21st. Returns to the house of her lover, where she has an attack of 
colic, and faints. 24th. Urine abundant — depositing a whitish sediment. 
From the 8th, the period of the invasion of the fever, we had recourse to a 
strencrtheninw reoimen, light tonics and exercise. 26th. The fever which 
presented all the characteristics of a continued catarrhal fever, became a ter- 
tian intermittent, and persisted all the autumn, and a part of the winter. In 
the spring following, the fever ceases, the patient gains flesh rapidly, and re- 
covers her gayety and ordinary vivacity. Since that period, she has obtained 
a divorce, married her lover, and become the mother of two children, whom 
she has nourished and educated with the greatest care. She subsequently 
met with the greatest misfortunes, and experienced domestic trials, without 
suffering in the least from aberration of mind. 

Case XIV. — N., thirty-one years of age, having always enjoyed excellent 
health, two months after her confinement, experienced a most trying mortifi- 
cation, in consequence of which, she became insane. At the moment of her 
admission at the Salpetriere, her countenance is animated, her eyes sparkling, 
her skin moist. The patient passes alternately, from cries and vociferations, 
from extreme agitation and loquacity, to repose and the most obstinate silence. 
She walks about at a rapid pace, pouring forth abuse, when suddenly she stops, 
becomes motionless, her eyes fixed, absorbed and indifferent to surrounding 
objects. Thus she passes her days and nights, without sleep or repose. This 
delirium continues for five months. She speaks simply in a low voice, and 
makes mysterious signs. Suddenly she utters a piercing cry, thinking that 
she recognizes the persons who surround her, and becomes furious towards 



OF THE RECENTLY CONFINED. 143 

them. Not far from the middle of the fifth month, her countenance becomes 
sallow, brown, and afterwards of an earthy hue. Her death takes place Oct. 
6th, 1815, six months after her confinement. 

Autopsy. Cranium thick and hardened; meninges and brain healthy. 
Thoracic viscera in their normal state. Sero-purulent liquid in the peritoneal 
cavity. Peritoneum thickened, greyish through its whole extent, and coated 
with a yellowish, albuminous covering. Mucous membrane of the alimen- 
tary canal, healthy and coated with a yellowish mucus. Liver soft, and easily 
torn. 

Case XV.— M. J. B., twenty-eight years of age, is the off'spring of a mo- 
ther, who, when forty-eight years of age, suffered from a slight attack of apo- 
plexy. When nine years old, she has the small pox. From seventeen to 
eighteen years of age, she is subject to violent attacks of cephalalgia, which 
disappear after the first appearance of the menses. At twenty-eight years of 
age, she is happily confined. She experiences many trials, and her lover 
abandons her. Six days after her confinement, delirium bursts forth. On 
the ninth day, she is admitted at the Salpetriere. At the time of her arrival, 
she is very much agitated, has hallucinations of hearing, mysterious voices 
commanding her to injure persons by whom she is surrounded. She believes 
herself in society, and affirms that she has never suffered from head-aches, 
but experiences acute pains in the limbs. No lochia. A large vesicatory is 
applied to the back, prolonged tepid baths are administered, and at first cool- 
ing, then laxative drinks. After some days, the delirium diminishes, and 
the'menses are established. Convalescence is protracted. The patient her- 
self demands that the vesicatory should be continued. Reason is soon estab- 
lished, and she goes from the hospital restored, after the second return of the 
menses. 



EPILEPSY. 



Synonyms and symptoms. — Medium duration and frequency of attacks. — Lunar influ 
ences. — Notices of the leading mental peculiarities in 339 cases of Epilepsy. — Verti- 
goes epileptic, their effect upon the mind. — Pathognomonic characteristics of Epilepsy. 
— Causes. — Organs upon which they primarily act. — Analysis of post-mortem examina- 
tions. — Diagnosis. — Divisions and subdivisions. — Feigned epilepsy. — Prognosis. — Re- 
marks preliminary to the details of treatment. — Attacks often lessened temporarily in 
frequency by a change of remedies. — Treatment, with a notice of numerous remedies 
employed in ancient and modern practice, with their effects. — Fear as a curative agent. 
— Hygienic influences. — Traveling. — Music. — Moral influences. 

The symptoms of epilepsy are so extraordinary, so entirely beyond the 
reach of any physiological explanation, and its organic causes so entirely un- 
known, that the ancients believed it to depend upon the wrath of the gods. 
Although Hippocrates may have combated this prejudice, he has preserved 
for it the appellation of the sacred disease. Areteus calls it 3Ial d'Hercule. 
It is the 7uorbus comitialis of Pliny ; the morbus sacer ct major of Celsus ; the 
morbus sonticus of Aldus Gelliits ; and the morbus caducus of Paracelsus. 
The sacred writers denominate those who suffer from this malady, lunatics. 
Epilepsy, which is confounded with eclampsia by many moderns, is designat- 
ed in France, by the names, mal-caduc, haut-mcd, mat de terre, mal de saint 
Jean, mal des enfans. In the west of France, epileptics are called tombeurs. 
The first intimation of an epileptic attack, is usually a cry from the patient, 
who immediately falls and suffers from convulsions of every grade of intensi- 
ty, from slight convulsive movements, to those of the most violent and terrific 
character. Consciousness is entirely suspended. The hair stands on end, 
the brow is knit, the eye-brows are depressed and drawn nearer together, the 
eyes project, and are haggard or crossed. The eyelids sometimes open and 
shut very rapidly for some minutes, leaving exposed and fixed, the inferior 
portion of the globe of the eye. In other cases, the eyelids remain open, and 
the eyes, strongly injected, seem to start from the orbit, and move convulsive- 
ly. The face is bloated and flushed, livid and ecchymosed. The muscles of 
the face produce hideous grimaces, the lips are prolonged, project or extend 
towards the ears, and are covered with a frothy saliva. The lower jaw is fix- 
ed in contact with the superior one, or is extended even to luxation. The 
tongue is lengthened, swollen, and projects from the mouth ; is seized, bruised, 
torn, and cut between the teeth, the grinding of which is so violent, that they 
are sometimes broken with a loud noise. The voice consists merely of groans 
and sighs, similar to that of a person strangling. Sometimes epileptics utter 

19 



146 EPILEPSY. 

howls, more or less prolonged and frightful. There are some, who utter 
words without connection, extravagant and strange, which knaves have caus- 
ed to pass, and simple people have taken, for the inspirations of demons. 

The vessels of the head are so much distended, and the carotids beat with 
such force, that they seem ready to burst. The whole head executes rotatory 
movements, is carried to the right or left, or from before backward. Some- 
times it is fixed in one or the other of these attitudes, or is thrown backward. 
The neck is rigid, and this fixedness or rigidity, cannot be surmounted by the 
greatest efforts. The trunk suddenly prostrated, now upon the back, and now 
upon the abdomen, raises itself only to fall again. It turns itself in various 
directions, bends itself, rolls upon the ground, or reposes in a true tetanic 
condition. The arms, hands and fingers, the thighs, legs, feet and toes, par- 
ticipate in this state. The flexure of the thumb is so common, that it has 
been regarded as a sign of epilepsy. 

The muscles of organic life are not indifferent to this scene of sufTerinff 
and terror. The pulse, at first small, is developed, becomes frequent, hard, 
unequal, and sometimes stops. Respiration is slow or hurried, convulsive or 
stertorous. Eructations, borborygmi and vomiting, the involuntary emission 
of urine, semen and feces, the perspiration which bursts from every pore, the 
blood, which starts from the nose, eyes and ears, all indicate the violent state 
of the organism. Sensibility seems extinct, so utterly impossible is it to 
arouse the patient by whatever means we employ. But when the vital princi- 
ple seems to be yielding to so much violence, and the patient about to suffo- 
cate, the muscles relax, respiration becomes more easy, the pulse slackens or 
is developed, sensibility is restored, the convulsions diminish, the physiogno- 
my assumes its ordinary appearance, the mind begins to return, the eyes that 
have been weighed down, open, and the look is one of astonishment. The 
limbs, fatigued and painful, need repose. Some epileptics after a sleep of 
longer or shorter duration, recover their energy. Others, after a long, coma- 
tose sleep, awake, and remain pale, languid and feeble for some hours, and 
even days. Immediately after the attack, and before recovering their senses, 
both the one class and the other, are affected with carphologia. The exercise 
of thought is immediately established with the former ; with the latter, it be- 
comes free, only after some hours, or days. 

No epileptic preserves a recollection of what he has experienced, nor has 
the least knowledge of it. All are sad after the attack, as if ashamed, and 
are exceedingly susceptible. Epileptic attacks are not always so formidable. 
The convulsions are not always general. There are persons who have only 
the premonitory symptoms of an attack. Others, experience only the earlier 
symptoms, which cease promptly. Sometimes, it is only a stunning sensation, 
a general shivering, followed by rigidity, or rather, a simple convulsive move- 
ment of a limb, the head or lips, with a momentary privation of thought. I 
have been consulted in behalf of a young lady, whose father is epileptic, who 
is seized with her attacks, in the midst of a company, while walking, or on 
horseback. She does not fall, but her eyes are convulsed, and her looks 
fixed. The attack lasts but a few seconds, and the patient resumes the con- 
versation at the phrase where she left off" speaking, without suspecting that 
any thing has happened to her, and unless she had uttered a cry, no one 
would have observed what had passed. With the progress of age, the attacks 
become more complete. Poupart* cites a similar case. Some epileptics 
merely shake the head, arms or legs; others only close the hands; some 
run, and others turn round and round. 

Doctor Esparron recognized an attack of epilepsy, by a simple convulsive 
movement of the lips. The convulsions merely, of the eyes and thorax ena- 

* Memoirs of the Royal Academy of Sciences ; 1705. 



EPILEPSY. 147 

bled Pechlin to ascertain the same fact. These attacks, which may be mista- 
ken, serve as a prelude to those, which by degrees, or with age, become com- 
plete, or rather intercalate with complete attacks, which leave no doubt re- 
specting the nature both of the one and the other. This is epileptic vertigo. 
Among infants, the attacks are less violent, and may be confounded with or- 
dinary convulsions. Children have vertigoes, and their limbs totter. Perspi- 
ration breaks out upon the face, which becomes red and bluish ; the eyes 
converge, and are fixed towards the root of the nose ; the convulsions are 
general or partial, and the jaws are set, or the lips covered with froth. When 
the attack has been light, children retain a stupid expression, are somnolent, 
complain of the head, and lift the hand to it. They are unwilling to nurse. 
If the attack has been violent, they fall into a profound sleep, from which 
they awake in a stupid condition. There are cases, in which attacks occur 
suddenly and without any premonition, particularly in constitutional epilepsy. 

There are others, which are announced by divers accidental circumstances, 
especially in sympathetic epilepsy. They are almost always foreseen, before 
the loss of consciousness takes place. Epileptic persons experience convul- 
sive movements and acute pains. They experience a sensation of cold, a 
vapor [aura cpileptica), in the head or face ; in one of the arms or hands ; 
in the thighs, legs or toes ; in the chest, stomach or uterus. These various 
sensations are propagated like a vapor, along the limbs, trunk and neck, to- 
wards the head, and when it reaches the brain, the attack bursts forth. Epi- 
leptics profit by these presentiments, in order to guard themselves against 
grave accidents, which might result from a fall. It is at this time that liga- 
tures are to be applied, that some physicians have advised the extension of the 
limbs, walking about, and the inhalation of some substances, strongly aroma- 
tic or stimulant. The redness at the root of the nose, the turgescence of the 
veins of the neck, the throbbing of the temporal arteries, the discoloration of 
the face, vertigoes, supineness, ringing in the ears, frightful reveries, palpita- 
tions and the flow of tears, are the precursory signs of angiotenic or plethoric 
epilepsy. Some, previous to the attacks, smell disagreeable odors ; others 
have a repugnance to food, which, together with vomitings, borborygmi and 
involuntary dejections, presage gastric epilepsy. Some are more irritable and 
choleric, and in other cases, the intellectual faculties are exalted on the day 
previous to, as well as on that of the attack. Immediately before the attack, 
says Areteus, some epileptics think they see a shining light, of a purple or 
dark color ; others hear a sound, as if some one was striking a resisting body 
with a stone or club. There are those who have hallucinations. We have at 
the Salpetriere one epileptic, who turns round and round for some minutes, 
and another, who runs with all her might until she falls. Nothing can stop 
them. 

The condition of an epileptic, forewarned by internal sensations, of an at- 
tack more or less immediate, is so painful and trying to many of this class, 
that they anxiously desire that it should occur ; seeking for those influences 
which experience has taught them, were favorable to its invasion. Some, 
with this intention drink wine and liquors ; others excite anger, by seeking a 
quarrel with the first person they meet. The duration of the attacks is very va- 
riable. Some last but a few seconds ; others, for some minutes. The medium 
period, is from five to fifteen minutes. The frequency of the attacks is not 
more determinate. They recur annually, every six months, monthly, every 
fifteen days, every eight days, on alternate days, daily, and several times a day. 
There are epileptics who have complete and very violent attacks, at very long 
intervals. During these intervals, they suffer from vertigo. The attacks of 
some have a fixed season of return, and recur at very determinate periods. 
In some cases, particularly among women, they recur on fixed days. Some- 



148 EPILEPSY, 

times the attacks alternate with respect to intensity. There are violent and 
feeble attacks. These are the forms, which they denominate in hospitals, le 
grand ct petit mal. More rarely, the attacks reappear at indeterminate pe- 
riods, and the epileptic then has several in succession, and at brief intervals. 
In some instances, the attacks occur during the day ; in others during the 
night ; and in others still, during sleep. I have had under my charge a young 
man, who became apprised of his attacks, only by the fatigue and dullness 
which he experienced on waking. Several times we succeeded in concealing 
from him the fact, that he had had an attack, 

I have in charge, a man thirty-two years of age, whose epilepsy is compli- 
cated with fury and dementia. His attacks occur only during sleep. If it 
happens, (which is very rare), that he has attacks during the day, he has slept 
immediately before its occurrence. If we prevent sleep, or awake him in time, 
the attack is avoided. I have advised the patient not to retire to bed, but to 
resist sleep by diversion. The attack passes by, but the sleep of the following 
day recalls it. There is no disease, which has been regarded as more depen- 
dent on the course of the moon, in consequence of its periodicity. Never- 
theless, the coincidence of the attacks with the lunar phases, is neither so con- 
stant nor so regular as has been supposed. Among large assemblages of epilep- 
tics, I have not observed that the attacks were more frequent, at certain pha- 
ses of the moon than at others. 

Authors relate, that epilepsy has ceased after the reestablishment of sup- 
pressed hemorrhages, or repelled cutaneous eruptions ; after pains in the thighs, 
ulcers in the throat, or upon the legs; after engorgements of the breasts or 
testes, and after blindness. This last crisis, is not very rare. Epilepsy is a 
malady not only formidable by the violence of its symptoms, and a cause of 
despair in consequence of its incurability ; but is still more so, by its fatal 
effects upon both the body and mind of those who are affected by it. The latter 
are the necessary consequences of the repetition of the attacks. The former 
are accidental, and may be prevented. The accidental effects of epilepsy, 
which I call local, and which may be prevented, depend upon the disasters 
which take place, at the commencement of an attack. An epileptic person 
may fall into the lire or into the water, or be precipitated from a window, etc. 
By falling, he may be wounded, or bruised ; he may disfigure his countenance, 
fracture a limb, or be drowned. These accidents are sufficiently frequent 
and grave, to furnish important indications in the arrangements of a hospital 
destined to be occupied by a great number of epileptic patients. The violent 
and oft-repeated perturbations of the nervous system, which take place in epi- 
lepsy, produce necessarily, in time, lesions in the organs of nutritive life, as 
well as alterations in the brain and its functions. The features of the coun- 
tenance enlarge, the lower eyelids puff up, the lips become thickened, and 
the handsomest countenances ugly. There is something uncertain in the 
look ; the eyes wander, and the pupils are dilated. We observe convulsive 
movements of certain muscles of the face. Epileptics have also a peculiar 
wait. Their slender arms and legs are no longer in relation with the size of 
the rest of the body. They become deformed and paralytic. The legs 
of an epileptic at the Salpetriere, after a violent attack, became flexed upon 
the thighs, so that she could not walk. A year after, during an attack, the 
limbs were extended and flexed alternately. The person who was by the 
patient at this time, succeeded by some effort, in maintaining the extension of 
them, and by this happy expedient, this epileptic is again enabled to walk. 

The functions of organic life are altered and languish. Epileptics are sub- 
ject to cardialgia, flatulence, spontaneous lassitude, and trembling. They 
take little exercise, and become either corpulent or lean. They are strongly 
inclined to the pleasures of love and onanism. Perhaps the excesses to which 



f.- 



EPILEPSY. 149 



they yield themselves, produce the organic lesions and disorders, which are 
manifest when the malady has persisted for a long time. In general, epilep- 
tics do not reach extreme old age. The cerebral functions and intellectual 
faculties, by degrees become greatly impaired. Areteus, who has so well de- 
scribed the symptoms of epilepsy, has not omitted to speak of the influence of 
this malady upon the functions of the brain. Van-Swieten in his Commen- 
taries upon Boerhaave, remarks, that he has seen many unhappy persons who 
had been weak-minded from infancy, and that all of them with whose history 
he had become acquainted, had suffered from attacks of epilepsy. The un- 
derstanding is altered, and gradually enfeebled ; the sensations no longer pos- 
sess their former vivacity ; memory is lost ; imagination becomes extinct ; and 
the epileptic sinks into incurable dementia. These fatal effects are the more 
to be feared, in proportion as the attacks are more violent and frequent. 

Assisted by M. Calmeil, medical inspector of the hospital at Charenton, 
and at that time a pupil at the Salpetriere, I have collected with the utmost 
care, the history of those women who occupy the epileptic ward, to the num- 
ber of three hundred and eighty-five. Of these, forty-six are hysterical. So 
analogous are the symptoms, that hysteria has sometimes been confounded 
with epilepsy. There are hysterical persons, who are at the same time, epi- 
leptic. But in those cases, a little experience enables us to decide, to which 
of the two disorders the convulsions to which the patient is subject, belong. 
Hysterical patients have attacks of mania, and almost all are hypochondriacs, 
but they do not fall into dementia. I have therefore, to give an account of 
only three hundred and thirty-nine epileptics, — subtracting the forty-six hyste- 
rical patients. Of this number twelve are monomaniacs. Thirty are maniacs, 
among whom, some have a disposition to commit suicide, and have made seve- 
ral attempts upon their lives. Thirty-four are furious, with three of whom, 
there is an irruption of fury, only after an attack. One hundred and forty- 
five are in a state of dementia, sixteen are constantly in this state, the rest, 
only after an attack. Two have paroxysms of fury. Eight are idiots. One 
of them has been epileptic only from seven to eight months, and has had but 
five attacks. Fifty are habitually rational, but suffer from absent-mind- 
edness more or less frequently ; or else from exaltation of the faculties. Some 
have a temporary delirium, and all a tendency to dementia. Sixty have no 
aberration of the understanding, but are exceedingly susceptible, irascible, 
head-strong, difficult about their living, capricious, strange ; all possess some 
peculiarities of character. Therefore, two hundred and sixty-nine of our 
three hundred and thirty-nine epileptics, that is to say, four fifths of them, are 
more or less insane; one fifth only retaining the use of their reason, but in 
what a condition ! Some epileptics experience internal sensations, from which 
spring presentiments, which warn them of an approaching paroxysm ; and 
that, although they may have just had one, another attack will immediately 
ensue. 

Many, previous to the entire suspension of sensibility, have hallucinations 
the most varied. They think that they see luminous bodies, by which, they 
fear that they may be embraced. They also believe that they see dark bodies, 
extended and immense, which threaten to shroud them in thick darkness. 
They hear sounds like the bursting of a thunderbolt, the roll of drums, 
the clash of arms in the din of combats. They smell odors the most fetid. 
It seems to them that they are struck, and unmercifully beaten. All these 
hallucinations inspire them with the greatest terror. Perhaps it is this senti- 
ment, which impresses upon the physiognomy of most epileptics, that expression 
of fright or indignation, which is peculiar to these patients during the attack. 
Almost all epileptics, on reviving from the somnolence which follows a com- 
plete attack, or after vertigo, are in a state of dementia, which gradually dis- 



150 EPILEPSY. 

appears. The reestablishment of organic sensibility, always precedes that of 
reason. Many epileptics suffer from a kind of carphologia, and make bundles 
of linen or other materials which they meet with ; or else move their hands 
about blindly, as if seeking to collect and bind together something; when, in 
fact, there is nothing within their reach. The fury of epileptics bursts forth 
after the attacks, rarely before, and is dangerous, blind, and in some sort, 
automatic. Nothing can subdue it, neither the appearance of force, nor mo- 
ral influence, which succeeds so well with other furious maniacs. This fury 
is so formidable, and so much dreaded, that I have seen in a hospital of the 
south, all the epileptics chained every night to their beds, in consequence of 
the fear which they inspired. I am unable to determine whether the mania 
of epileptics, has any connection with the frequency of the attacks, or with 
the vertigoes. It bursts forth among those already in a state of dementia, and 
even among subjects who enjoy habitually the use of their reason. Dementia 
is that form of mental alienation, which most generally threatens epileptics. 

A young man, twenty-six years of age, having become epileptic in conse- 
quence of having given himself up to the practice of onanism, was exceed- 
ingly irritable after his attacks. The slightest opposition produced fury. He 
had conceived a strong aversion to his parents. To these symptom.s, is joined 
a orloomy melancholy, attended with a disposition to commit suicide. Neither 
tonics, cold baths, nor indeed any thing can prevent his sinking into dementia, 
of which he already manifests some symptoms. 

A lady, now thirty-four years of age, has been epileptic from infancy. Her 
mind is feeble, and at the age of puberty, she became a maniac. She is 
married, and has one child. Some domestic troubles produced fury, and the 
attack lasted about a year. Since this period, that is, since the age of twenty- 
four years, this lady has often had delirium, and sometimes fury. The at- 
tacks of epilepsy take place during the night, and it is before the attacks that 
fury bursts forth. Dementia is imminent. With respect to its duration, the 
mental alienation of epileptics is now ephemeral, and takes place, only after 
the attacks, particularly mania accompanied with fury, and an inclination to 
suicide. Nevertheless, its duration extends from a few minutes or hours, to 
several days. Now it is permanent ; particularly dementia. It is independent 
of the return of the attacks, and persists from one to another. 

Whatever may be the form and duration of the mental alienation of epilep- 
tics, it takes place, sometimes at the first, or among the earliest attacks, par- 
ticularly in infancy. In the case of some epileptic children, reason is not 
developed; they are idiots. With others, it is developed, but is speedily lost. 
When epilepsy appears after puberty, and especially adult age, reason yields 
more slowly ; but each attack adds to the feebleness of the intelligence, be- 
fore dementia is complete. The progress towards dementia, is in proportion 
to the number of years that have elapsed, since the invasion of the first attack. 
It is more to be feared, and is more rapid, when the attacks occur, at inter- 
vals increasing in frequency ; whilst reason is preserved, when the attacks are 
rare, when they are not many times repeated on the same day, and when there 
are not vertigoes. This tendency to dementia is more directly allied to the 
frequency of the vertigoes, than to that of the epileptic attacks. Vertigoes 
have a more active and energetic effect upon the brain, than what is called, 
le grand mal, or the complete attack. Vertigoes destroy the intelligence, both 
more speedily, and with more certainty than the attacks, although they may 
have scarcely an appreciable duration. There are indeed, individuals who 
have vertigoes, in presence of persons who can no more perceive them, than if 
they did not occur. When epilepsy ceases, or when it is suspended for a 
longer or shorter period of time, (and it ceases sometimes for years), or the 
interval between the attacks increases, though the malady does not cease, the 



EPILEPSY. 151 

understanding is progressively recovered, and the dispositions of the subjects 
of it are ameliorated. They are less irritable, more mild, more sociable ; but 
I have never seen one, who did not preserve a very marked physical and moral 
susceptibility. How happens it that vertigoes, whose duration is so brief, and 
where convulsions are scarcely perceptible, produce a more fatal effect upon the 
brain, and destroy more promptly the understanding, than complete attacks of 
epilepsy, whose convulsions are more violent and lasting? How happens it 
that hysterical convulsions, which are so intense, and which persist durinor 
many hours and even days, do not produce dementia, like epileptic seizures, 
and more especially vertigoes? Does not this last observation serve to confirm 
the opinion of those, who pretend that both hysteria and epilepsy, have their 
primitive seat in the brain? Such is the general course of this terrible dis- 
ease. 

Amidst so many, and such varied symptoms, by what signs shall we recog- 
nize epilepsy ? The confusion, and fall at the commencement, or during the 
attack, takes place in syncope, asphyxia, and apoplexy. The convulsions, 
which are now general, now partial, now extremely violent, and now scarcely 
appreciable, are not constant, and appertain to other neuroses. The same is 
true of the frothing at the mouth, which exists sometimes in apoplexy, as- 
phyxia and hysteria. The involuntary emission of urine and semen, is not a 
symptom confined to epilepsy. The strong contraction of the thumb, and its 
occlusion, are not constant. The pathognomonic character of epilepsy, consists 
in convulsions, the entire suspension of sensibility, and loss of consciousness. 
Epilepsy is therefore a convulsive or clonic malady, with loss of conscious- 
ness. Epilepsy differs from apoplexy. In the latter, respiration is stertorous, 
there are few if any convulsions, and the pulse is scarcely altered. It is usu- 
ally fatal on the second or third attack. We cannot confound epilepsy with 
syncope, from which it is sufficiently distinguished, by the flushed counte- 
nance, the freedom of the pulse, the relaxation of the muscles, and the recol- 
lection of the state which he escapes who has had syncope. 

Hysteria has been often mistaken for epilepsy, and reciprocally. Hysteria 
however, only appears at puberty or subsequently. The attack docs not burst 
forth suddenly, and is preceded or accompanied by globus hystericus, or con- 
striction of the throat. In epilepsy, the convulsions are concentrated, and 
seem to tend towards the axis of the trunk, and are more violent on one side 
of the body than the other, or in one member than in the others. In hysteria 
the convulsions are, so to speak, expansive. The members extend and pro- 
ject themselves as far as possible, are more fully developed, and the convul- 
sions are more uniform. The features also, are less altered, and the counte- 
nance is less hideous and injected. In hysteria the abdomen is distended, 
there are borborygmi, the patient does not lose his consciousness, nor does he 
fall into a comatose state after convulsions, but preserves a recollection of 
what he has just experienced, and there is less prostration after the attack. 
In the intervals, some hysterical symptom always betrays the nature of the 
malady. Hysteria, even when prolonged, never destroys the intellectual facul- 
ties. The causes of epilepsy are general or special, remote or proximate. 
Certain authors assure us that epilepsy is endemic in some countries. Is it 
not most frequent in mountainous countries ? Hippocrates classes it among 
the maladies of spring. Is epilepsy contagious ? Yes, by the fright which 
an attack inspires. Powerful moral impressions, received by the mother dur- 
ing pregnancy, communicate it to the foetus, and those which the nurse re- 
ceives, by changing the quality of the milk, have also caused epilepsy. Are 
children who have been conceived during the menstrual period, more exposed, 
on this account, to the malady ? 

Epilepsy attacks persons of every age. However, it is so common in infan- 
cy, and so rare at adult age, particularly in advanced life, that it has been call- 



152 EPILEPSY. 

ed, mal chs cnfans. The readiness with which it is contracted, is in an in 
verse ratio to the age ; but we must add, that if this malady is more common 
at the earlier periods of life, it is also more easily cured. The extreme sus- 
ceptibility of the nervous system, the presence of meconium, intestinal 
worms, the labor of dentition, the bad quality of the milk of nurses who give 
themselves up to errors of regimen or to their passions, are also circumstances, 
which more particularly expose children to epilepsy. Falls, and ligatures with 
which the bodies or heads of infants have been too tightly compressed, have 
often caused this malady. 

Women and children, being more feeble, susceptible and impressible than 
men, are more subject to epileptic seizures. This predisposition with respect 
to sex, is not perceivable from birth until the age of seven years. At this 
period, the character of either sex is delineated, becomes marked, and distin- 
guishes itself; and it is then, that the number of epileptic women predomi- 
nates. By comparing the number of epileptics at the Salpetriere, with the 
men suffering from the same malady, who have been admitted at the Bicetre, 
we find the number of epileptic women the greater by one third. There are 
at the Bicetre, one hundred and sixty-two epileptics, and three hundred eighty- 
nine at the Salpetriere. Melancholic temperaments, enfeebled, scrofulous, 
and cachectic constitutions, predispose to epilepsy, as well as scurvy, rachitis 
•and syphilis. Errors of regimen, onanism, insolation, blows and falls upon the 
head, the abuse of alcoholic drinks and poisons, are the exciting causes of 
epilepsy. 

M. C., a native of Boston, aged nineteen years, made a voyage to France. 
Whilst sailing under the line, he lays down upon the deck and falls asleep. 
Shortly after, he is awoke by a dreadful headache, and an inflammation of the 
face and scalp. The whole head becomes enormously swollen, the patient 
has delirium, and they believe him lost. However, he is several times bled 
copiously, the inflammation diminishes, and ceases on the ninth day : but im- 
mediately after, epileptic attacks appear. The young patient is put on shore 
at L'Orient, where he is treated for six months ; after which, he is sent to Pa- 
ris, and committed to my care. The following is the condition in which I 
first saw him. In stature, he is of middle size, his hair is light colored, his 
eyes blue and very lively, physiognomy mobile, and his habit moderately full. 
There is an habitual cephalalgia, and obstinate constipation. The epileptic 
attacks recur every seven or eight days. They commence with a maniacal 
state. The patient suddenly begins to walk his chamber, soon after he leaps 
about, and overturns whatever comes in his way. He throws himself with a 
kind of fury upon those that surround him, and after a few moments' strug- 
gle, utters a cry. Convulsions of the face, eyes and limbs, together with loss 
of consciousness, complete the attack, which lasts six or seven minutes, and 
which is followed by a comatose state, of half an hour's duration, from which 
the patient comes forth, with his full measure of intelligence, and a very acute 
pain in the head. All the remedies advised as a cure for epilepsy, had failed 
at L'Orient. Having reference to the cephalalgia, which was frequently re- 
newed during the course of the day, and to the obstinate constipation, which 
always announced a coming attack, after having prescribed an appropriate 
alimentary regimen, and abundant exercise, I put the patient upon the use of 
pills, prepared with the Ext. Colocynth, Asafoetida, and Calomel. At the 
same time, the young patient exposes his head occasionally to the flow of cold 
water from the spout of a pump. This impression of cold, repeated many 
times a day, by diminishing the cephalalgia, renders the attacks at first less 
violent, and terminates them in the course of three months, by removing both 
the headache and the attacks. This young man spent some months after 
this period at Paris, and finally, took passage for Boston, where he arrived in 
very good health, and from whence I have learned that he continued well. 



EPILEPSY. 1 53 

The metastasis of a chronic cutaneous eruption, the suppression of an nicer, 
the cessation of an habitual evacuation, are also causes of epilepsy. Military 
physicians have had occasion to observe, that the suppression of transpiration, 
sometimes renders soldiers epileptic. A woman seventy years of age, says 
Zacutus, had, for eighteen years, an ulcer upon the wing of the nose. A 
charlatan cures it by an external application. Twenty-four hours after this 
was effected, she had a first attack of epilepsy, and several afterwards, until 
two issues were established upon the legs. A man thirty years of ao-e, re- 
ceives a blow upon the head. A year after, the wound heals, and epilepsy 
bursts forth. The wound is opened again with the cautery, and the epilepsy 
ceases. An imprudent surgeon induces cicatrization ; the attacks are renew- 
ed, and again cease on a new application of the caustic. 

Doctor Maisonneuve* speaks of a young man, nineteen years of age, who, 
at the age of eight years, having washed his head repeatedly with cold water, 
in order to cure tinea capitis, succeeded in removing it. Some days after, 
he was seized with epilepsy. The attacks were least frequent during the 
summer. Cartheuser had remarked, that the improper practice of repellino- 
tinea capitis with cold lotions, which was established in Sweden, had render- 
ed epilepsy frequent in that country. Epilepsy is caused by syphilis. Omo- 
bon, Pison and Scardona, relate examples of it. Cullerier published in the 
General Journal of Medicine, (t. xiv, p. '271), two cases of epilepsy, caused 
by syphilis, and cured by an anti-venereal treatment. In these two cases, 
and in a third, related by M. Maisonneuve, the intervals between the attacks 
were marked by sufferings, which betrayed the presence of an ever-acting 
morbid cause. Tissot assures us, that epilepsy has been caused by the sudden 
suppression of the salivation, produced by the use of mercury. Hoffmann 
speaks of mercury, as capable of causing epilepsy among feeble persons. M. 
Landre-Beauvais has often noticed it, as a result of the mercurial treatment. 
Epilepsy is symptomatic and transient, among children suffering from variola, 
rubeola and scarlatina. It occurs, when these eruptions do not appear at a 
proper time, or are suddenly suppressed. Accoucheurs have regarded as epi- 
leptic, the convulsions which complicate the labor of confinement. 

Violent moral commotions, the violent passions, such as chagrin, anger, and 
above all, fear, are the most frequent causes of epilepsy. This malady is 
caused, also, by strong mental conflicts, associated with an improper regimen. 
The sight of an epileptic seizure, and the habit of feigning epilepsy, have 
provoked this malady. A mason, twenty-one years of age, strong and robust, 
is frightened during a dream, and becomes epileptic. A servant untying a 
leathern strmg, tied in three knots, imagines that these knots are the work of 
a witch. She is frightened, and is taken with an attack of epilepsy. A wo- 
man is frightened by an insane person, and becomes epileptic. A girl, nine 
years of age, amuses herself with looking at the sun. After some minutes, 
she believes that she sees in the midst of it, a huge black head. She is 
frightened, and on the same evening, whilst relating to her mother \vhat she 
has seen, is seized with a first attack. The same physical and moral pheno- 
mena which have induced the first attack of epilepsy, become the cause of 
succeeding ones, although they may act with less intensity. A woman meets 
with a severe mortification, and becomes epileptic in consequence of it. Af- 
terwards, the slightest chagrin produces an attack. 

A child is frightened by a dog, and becomes epileptic. He afterwards has 
an attack every time he hears the barking of a doo-. Another becomes epi- 
leptic after a fit of anger. The slightest contradiction, afterwards produces 
an attack. A little girl ten years old, is at play with her companions, who 
tickle the soles of her feet. She becomes epileptic. An attack occurs every 

** Researches and Observations on Epilepsy, Paris, 1803, in 8vo. 

20 



154 EPILEPSY. 

time they threaten to tickle her. Impressions made upon the senses, an un- 
expected noise, certain colors or odors, sometimes produce attacks. The heat 
of an apartment, the movement of a large assemblage of persons, the slight- 
est error of regimen, atmospheric vicissitudes, watchings, etc. ; in a word, 
whatever may have provoked the first attack, may become the cause of suc- 
ceeding ones. A soldier rushes to the assault, a bomb bursts near him, and 
he is seized with epilepsy, from which he is restored, in the space of a year. 

Twenty years after, the sight of the same ramparts, produces an attack. 
From the facility with which the attacks are reproduced from the slightest 
exciting causes, it seems proper to infer, that there remains in the organism 
after the first attack, as well as in the nervous system, a special disposition, 
which, from the least cause, is set in action, and occasions new attacks. This 
disposition, which Tissot denominates proegumene, merits the greatest atten- 
tion in the prophylactic treatment, but is no more easy to explain, than the 
periodicity of epilepsy. We no more find the traces of it in the organism, 
than we find in the organs, lesions, proper to acquaint us with the seat of 
epilepsy. 

After having pointed out the causes of epilepsy, I will indicate the organs 
upon which they seem to act primitively, in order to produce this malady. 
At one time, they exercise their influence upon some organ, more or less re- 
mote from the brain, and produce sympathetic epilepsy ; at another, they act 
directly upon the brain, to produce its idiopathic form. In sympathetic epi- 
lepsy, the causes act primarily upon the organs of nutritive life, or rather 
upon those of the life of relation. Is the digestive apparatus the seat of epi- 
lepsy ; the attacks burst forth when there exists an active gastric irritation, or 
when there is accumulated in the stomach or intestines, particularly among 
children, mucous matters, acid or otherwise ; or when there has been intro- 
duced into this viscus, irritating or deleterious substances. These patients ex- 
perience pains in the stomach, and tension in the epigastric region, with all the 
signs of gastric embarrassment. They are also fastidious. A little before the 
attacks, they have fainting turns, pains about the heart, nausea and vomitings, 
which are renewed during the attack. When epilepsy is caused by worms, 
the patients offer all the signs which announce their presence. That epilepsy 
which, I shall call intestinal, is announced by certain signs. Children who, 
without a fall or fright, become epileptic ; who, at the same time, have a pale" 
countenance, swollen cheeks, the eyes dull, and pupils dilated, the dejections 
greyish, abdomen voluminous, the gait dull and lifeless, and whose attacks 
are announced by borborygmi, leave no doubt as to the true seat of the evil. 
When the liver is primarily affected, respiration is interrupted, the diaphragm 
is painfully moved, the abdominal muscles are convulsively exercised, the pa- 
tient loses his consciousness, and some moments after, eructations and bor- 
borygmi take place. The jaundice, which appears before, or after the attack, 
slowly disappears ; the patient complains of a pain in the region of the liver, 
and vomits yellow matters. Hippocrates has referred to the bile as a cause of 
epilepsy : Fabricius has attributed it to biliary concretions. 

It was only after numerous observations, that Hippocrates, and all who have 
succeeded him, regarded sanguine plethora, as one of the causes of epilepsy, 
especially in youth. The sanguine temperament, the approach of puberty, 
the delay or suppression of the menses, the cessation of some habitual hemor- 
rhage, such as bleeding at the nose, or hemorrhoids ; whatever can give the 
blood a tendency to the head, insolation, violent exercises, the abuse of alco- 
holic drinks, are circumstances that provoke sanguine or plethoric epilepsy. 
The patient suddenly loses his consciousness, the countenance becomes tu- 
mid, is very red and covered with perspiration ; the eyes gleam, the respira- 
tion is blowing, the convulsions are not very violent, and last but for a short 
time. After the attack, the patient passes hours, and sometimes days in a 



EPILEPSY. 155 

comatose statef, rom which he recovers but slowly, and to which succeeds 
delirium, and sometimes fury or paralysis of some member. The attacks are 
less frequent than in the other varieties, recurring, ordinarily, but once a month. 
In the interval, between one attack and another, the patients have vertigoes, 
and torpor of the faculties. On opening the bodies, we find the vessels of 
the head dilated, and gorged with blood, and the cerebral substance strongly 
injected. 

The suppression of the menses more frequently produces epilepsy, than that 
of hemorrhoids ; because the menses are a physiological phenomenon, whilst 
hemorrhoids are an indication of deranged health. The organs of reproduc- 
tion are also the seat upon which the epileptic cause primarily acts, and from 
whence, as by irradiation, depart the first phenomena of the attack. This 
variety which we may call genital, is most frequent among women, and dif- 
fers, as we have already said, from hysteria. There is so strong an analogy 
between a slight epileptic attack, and the spasmodic orgasm which accompa- 
nies the act of reproduction, that the ancients have defined coition to be epi- 
lepsia hrevis. This act is sometimes followed by epilepsy. Sauvages speaks 
of a person, in whose case, coition was always followed by an attack. G. 
Cole cites the example of a woman, who, three days after her marriage, be- 
came epileptic. Onanism predisposes to this terrible malady, and becomes the 
exciting cause of it, even in childhood. Zimmermann knew a young man 
who had an attack whenever he committed the act of onanism. A young 
man, from twelve to thirteen years of age, gave himself up to masturbation. 
Although strong and robust, he becomes extremely susceptible, and at the age 
of fifteen years, is seized with an attack of epilepsy. The attacks coin- 
cide with the first quarter and full of the moon, and burst forth suddenly. 
The patient is prostrated and utters a cry, convulsions are general ; the eyes, 
open and fixed, are injected, and the pupils are very much dilated. After the 
attack, which lasts from three to four minutes, the patient remains very 
much fatigued during the whole day. Vertigoes are r.ire between the attacks. 
He is habitually extremely susceptible, and is mortified and grieved on the 
slightest cause. Tonics, peruvian bark, valerian, river baths, swimming and 
corporeal exercise, together with a very active life, contribute after six months, 
to diminish the frequency of his attacks. After the lapse of a year, they are 
no longer renewed, and the patient is regarded as cured. The pleasure of 
again seeing his mother, from whom he had been separated for two years, 
recalled the attacks, but they were more mild. At length, after six months 
more of the same treatment, he was restored to perfect health, since which 
period he has been engaged in commerce, and traveled much. His health 
was invigorated by it. He married at twenty-seven years of age, and is now 
remarkably well. I analyze only this case, which we may say in passing, 
proves better than any reasoning, the efficncy of regimen and corporeal exer- 
cises, in triumphing over a malady, at once so grave and rebellious. Conti- 
nence has sometimes produced epilepsy ; but excess in this respect is less to 
be feared than the opposite abuse. With respect to the marriage relation, I 
owe to the kindness of Doctor Hebreard, physician at the Bicetre, the follow- 
ing note : Of one hundred and sixty-two epileptic men, residing at the Bice- 
tre, one hundred and nineteen are single, thirty-three are married, seven are 
widowers, and one is divorced. 

The delay, suppression and derangement of the menses, pregnancy, and 
the labor of confinement, have caused epilepsy. M. Maisonneuve speaks of a 
young woman, twenty-two years of age, who became epileptic, in conse- 
quence of the derangement of the menses, and was cured by their reestab- 
lishrnent. Another young woman, twenty-three years of age, had attacks at 
each menstrual period, except when the discharge was abundant. The same 
author cites the example of a widow, thirty-one years of age, whose turns 



156 EPILEPSY. 

were suppressed by a strong impression, and who became epileptic. Fernel 
and Schenckius, have seen women, whose attacks were renewed only during 
the period of pregnancy. Horstius speaks of a woman thirty-two years of 
age, whose menses were scanty, and who became epileptic. The attacks re- 
curred every fifteen days. Having married nine months after, she became 
pregnant and was cured, I have seen some epileptics become pregnant, with- 
out having remarked the least modification in the intensity or frequency of 
the attacks. Lamotte speaks of a woman, who had, in eight pregnancies, 
five daughters and three sons. She had several attacks of epilepsy, every 
time she was pregnant with a son, but never during the pregnancies with her 
daughters. Mauriceau has seen epilepsy take place after confinement. 

If epilepsy has its seat in the digestive apparatus, in the circulatory system, 
or in the organs of reproduction, there are causes which act primarily upon 
organs placed at the surface. I will sum up, what has been said on this 
point. Fernel has seen the precursory symptoms, and the first symptoms of 
the attack, experienced at the crown of the head, and renewed, every time 
thBt the head was pressed. Doctor Vigne, a distinguished physician of 
Rouen, was consulted by a young man, eighteen years of age, who had be- 
come epileptic in consequence of a psoric affection. The patient experienced 
an icy coldness at the middle of the forehead, by which he was forewarned of 
an attack. For three years, Doct. Vigne applied himself to recall the erup- 
tion to the surface. He succeeded, and the patient was restored. Brunner 
eflfected a cure, by applying a moxa to the neck, at the point where the first 
symptoms were experienced. Fabrice met with the same success, by extract- 
ing a glass ball, whose introduction into the ear had caused epilepsy. Donat 
had charge of a nun, who experienced at the commencement of the attacks, 
a pain in the right breast, from whence the aura ascended to the brain. If 
the breast ulcerated, the attack was prevented. Hollier says, that in the case 
of one young man, the attack began at the shoulder, the arm was seized with 
trembling, the jaws were locked, and the attack took place. In another case, 
numbness of the right hand was the first symptom, the three first fingers were 
firmly contracted, the arm also was twisted, the body bent, and the patient 
fell. The attack of another, began in the little finger of the left hand. Tis- 
sot gives the example of a man who prevented an attack, by applying to the 
arm a tourniquet, which he tightened, so soon as he experienced pain in the 
left hand. M. Maisonneuve knew a man, in whose case the attack made its 
irruption, by convulsions of the arm and eyelids of the right side. If at the 
commencement of these convulsions, the arm was violently pulled, the attack 
was prevented. The effect was the same, if the patient ran. This circum- 
stance recalls to mind another patient, who prevented the attacks by throwing 
the head back, as far as possible. Professor Alibert relates, that an epileptic 
was accustomed to lessen the gravity of the attacks, and preserve his con- 
sciousness, by causing a gun to be fired near him several times, on the day of 
the attack. 

In other cases, the attack commences in the leg, from whence there arises 
a vapor, like a cold wind, along the thigh, the back and the neck, to the head, 
when the attack bursts forth ; or rather the attack announces itself by a pain 
in the top of the foot, from whence arises a cold current of air towards the 
head. A man who has an ulcer on the leg, causes it to cicatrize. Epilepsy 
follows ; and each attack begins with a cold wind, which proceeds from the 
cicatrix. A ligature above the knees, checks the attack. A lady, who had 
employed many remedies, was cured by the amputation of the first phalanx 
of the great toe, from whence the epileptic aura, proceeded. 

A child of eleven years of age, had suffered from two or three attacks a 
week, from the age of two years. Each was announced by a feeling of un- 
easiness and cold, proceeding from the right side. Doctor Carron discovered 



EPILEPSY. 157 

on the thumb of an epileptic person, a small indolent tumor He made an 
incision into it, and removed small hard bodies, of the size of a millet seed, 
of a sebaceous nature. The child was cured. Doctor Pontier cured an epi- 
leptic by cauterizing the saphena nerve of either leg. These two last cases 
are found in the General Journal of Medicine of Paris, tom. xiii, p. 242, and 
tom. xvi, p. 261. 

We must therefore, discover the causes of epilepsy, which act, at first, upon 
the internal organs, or those situated externally, before exercising their action 
upon the brain. However inexplicable may be these phenomena, however few 
the relations which subsist between these local impressions, and a complete 
attack of epilepsy, it cannot be denied that the first cause of the evil acts pri- 
marily elsewhere than upon the brain. Willis, Pison and Demoore, pretend 
that epilepsy ever has its primitive seat in the brain. 

Is not the contrary demonstrated by the cases of sympathetic epilepsy col- 
lected by all authors ? Is it not established by the cures that take place after 
the evacuation of the meconium, of the mucous, acrid, yellow and black mat- 
ters ; of worms, and biliary concretions, in gastric epilepsy ? The cures 
which take place after the first menstrual discharge, after the reestablishment 
of the menses, after marriage, and after pregnancy in uterine epilepsies ; the 
cure by blood-letting, and sanguine evacuations in plethoric epilepsies ; the 
cure, by the extraction of foreign bodies, by cauterization and amputation j 
by the reestablishment of an ulcer; the averting of the attacks, by the liga- 
ture of the member from whence the epileptic aura proceeds, and by the ex- 
tension of the limbs ; are not these, numerous and incontestable proofs, that 
epilepsy has not always its primitive seat in the brain, or its first point of de- 
parture from it ? 

Idiopathic epilepsy commences almost with life, it has characters peculiar 
to it, and is the despair of physicians. The first invasion takes place in ear- 
liest infancy, and its attacks are, at first, incomplete. They occur without pre- 
cursory signs, the convulsions are slight and most marked in the countenance. 
Their duration is short, and their return irregular, but at brief intervals. 
Sometimes the attacks cease for a long time, to appear again after many years. 
According to Hippocrates, they disappear at puberty. They may however 
persist even to old age, and do not seem to shorten life. The cessation of the 
menses, now augments, and now diminishes, the frequency and gravity of the 
attacks. 

Hereditary predisposition, strong impressions made upon the mind of the 
mother during pregnancy, epileptic attacks during confinement, and vivid 
moral commotions on the part of the nurse, are the most common predispos- 
ing causes in idiopathic epilepsy, although denied by some authors. Tissot, 
in his " Treatise on Epilepsy," at first admits an hereditary influence, but 
afterwards, rejects it. Doussin Dubreuil, decides against hereditary influence. 
Other observers believe that epilepsy can be transmitted hereditarily, and 
cite facts in support of their opinion. Saillant,* Maisonneuve, and Hoffmann, 
cite numerous examples, as interesting as conclusive, in favor of the heredi- 
tary nature of epilepsy. From the examples which I have gathered from our 
epileptic women at the Salpetriere, epilepsy is more frequently transmitted by 
the father than the mother, while the contrary is true with respect to mania. 
When the eyes of children are convulsive, when they have tumors upon the neck, 
and a shrill voice ; when they are affected with a dry and obstinate cough ; 
when, on becoming larger, they experience abdominal pains, unattended with 
diarrhoea ; when there supervene swellings of the testes ; when one hand be- 
comes emaciated, an arm impotent, or when the legs are weak, without an as- 
signable cause ; when children are seized with fear without cause ; when they 

* Memoirs of the Royal Society of Medicine, t. iii, p. 305, and t. v, {). 89. 



158 EPILEPSY. 

cry aloud, weep, yawn, and continually rub the forehead ; when their sleep is 
interrupted by reveries ; if they have convulsions, we ought to suspect the 
existence of epilepsy, especially if the father and mother are affected with the 
same malady. If convulsions supervene at a more advanced age, these com- 
memorative signs aid us in recognizing essential epilepsy. They will enable 
us to appreciate the influence of symptoms, which we regard as the proximate 
cause of epilepsy ; such as gastric embarrassment, worms, suppression of the 
menses, etc. Are not these disorders, the eft'ect of preexisting epilepsy, or 
that of the circumstances, which have favored the development of the mala- 
dy ? If so, what opinion ought we to entertain respecting medicines, proper 
to evacuate the bowels, reestablish the menstrual flow, and expel worms ? 
Hebreard* proves, that the expulsion of worms is not sufficient to remove epi- 
lepsy ; their presence often being only a complication. Medicines have been 
increased in quantity, and the attacks have increased in frequency, because 
we did not reach the true source of the evil. 

To these causes of essential epilepsy, a great number have been added. 
We remarked above, that sanguine plethora has been admitted by all authors. 
Hippocrates admits the superabundance o{ phlegm, as one of the causes of 
idiopathic epilepsy. Moral affections, by acting upon the brain, produce 
essential epilepsy. That which is caused by anger, is less permanent. Fright 
and chagrin make more profound and powerful impressions, the effects of 
which are more difficult to cure. We place also, among the causes of idio- 
pathic epilepsy, vices of conformation in the cranium, and lesions of the 
meninges and brain. A rapid analysis of what has been observed at the post- 
mortem examinations of those who were afflicted with epilepsy, will be the 
means of determining, if it be possible to do so, the seat of idiopathic or 
essential epilepsy. 

Leduc remarked, that the heads of epileptics are very large, the bones of 
the cranium very thick, and the sutures effaced. Lorry has confirmed this 
observation. Bontius found the cranium deformed, and Morgagni observed 
the same in a great number of subjects. The celebrated Dumas measured 
the facial angle of many epileptics, and concludes from his researches, that 
children are exposed to epilepsy, in proportion as their facial angle approaches 
seventy degrees. Bontius found in one case, the occipital bone nine lines in 
thickness, and Zacchias found the internal table of the same bone, destroyed 
by caries. Bontius saw an infant of six weeks, who was rendered epileptic 
by the pressure of the folds of its cap, and who was cured by removing this 
covering. The same author relates the case of a young man who, having re- 
ceived in infancy blows upon the head, became epileptic. Bonet cites similar 
facts. We have often met with osseous concretions, developed upon the falci- 
form process of the dura-mater. These concretions are now round, now 
lengthened and sharp. In making the post-mortem examination of an epi- 
leptic, twenty-three years of age, who died during an attack, I found adher- 
ing to the internal face of the dura-mater, an ovoid, osseous tumor, eight 
lines in diameter, depressing the superior convolutions of the brain. 

Are not the various eff'usions observed, between the meninges and the cra- 
nium, and in the arachnoid cavity, rather the effects, than the cause of the 
malady T We have often found the vessels of the meninges dilated, engorged, 
and varicose, containing fibrous and osseous concretions. What inference are 
we to draw from tliese alterations of the brain ? Morgagni says, that in 
the case of a woman, epileptic for two years, the anterior third of the lefl; 
lobe of the brain, very much depressed, was reduced to an extreme softness, 
and in that of a young man, the bed of the optic nerve of the right side re- 
sembled brownish colored pap. The brain of eight epileptics, appeared to 






Medical Library. 



EPILEPSY. 159 

Greding* to be softened. Morgagni, Greding, Meckel and Boerhaave, found 
the brain of epileptics hard, and even callous. The size of the ventricles of 
the brain, the presence of a fluid more or less abundant in them, and the se- 
rous cysts, developed in the tissue of the choroid plexuses, offer varieties 
without number, yet furnish no positive data. There have been found, within 
the cranium of persons who have died of epilepsy, scirrus, tuberculous, fibrous 
and osseous tumors, developed in the ventricles, and in the substance even, of 
the brain. 

Bauhin and Borrichius, have seen abscesses in the white substance. Bar- 
tholin removed a portion of a sword from the cavity of the brain. Didier ex- 
tracted a musket ball from the anterior part of this organ. The pineal gland 
so often contains osseous concretions, that this alteration proves nothing. 
Baillie and Soemmerring, found this gland very hard, while Greding found it 
soft in twenty-five cases of epilepsy. He also assures us, that among twenty 
epileptics, ten had the pineal gland surrounded with serum. The pituitary 
body has been the special object of the researches of Wenzel. This author 
has pointed out many alterations in the osseous portion which forms the sella 
turcica, and the apophyses which surmount it. At one time, there are defects 
of conformation, at another, caries. Among twenty epileptics, Wenzel found 
in seven cases, the pituitary body enlarged ; in ten, he found in its interior, a 
yellow, solid, pulverulent matter; in five, instead of this solid substance, there 
was a thick, viscous fluid. This body often presented to him traces of in- 
flammation, when there was no alteration of the brain or its meninges. Wen- 
zel indeed, constantly observed some alteration in the pineal gland ; but, asks 
this writer, are these lesions, the cause or effect of epilepsy 1 

Neither the alterations of the cranium, nor the lesions of the intra-cranial 
organs, teach us what is the seat, or what are the organic lesions, of which 
this malady is the expression. Authors have neglected to mention, in their 
autopsies, the state of the spinal marrow and its membranes. Assisted by M. 
Amussat, then a pupil at the Salpetriere, and who now stands so high in pub- 
lic estimation, I endeavored to repair this omission. In order to lay open and 
remove the marrow, M. Amussat invented the instrument called the rachitoine, 
which enables us to ascertain the condition of the spinal marrow, in fatal 
cases of epilepsy. In the case of twelve epileptic women, ten of whom 
died between the first of February and the first of June following, we found 
the meninges injected in one case, and in two of a greyish aspect. In nine 
cases, there were concretions, more or less numerous, disseminated through- 
out the whole extent of the external face of the arachnoid covering of the 
spinal marrow. These concretions, which were of a lenticular form, were 
from one to three lines in diameter, and one line in thickness. Most were 
cartilaginous, the remainder, osseous. We found, in four cases, the substance 
of the rachidian prolongation, altered and softened ; particularly the lumbar 
portion, and the arachnoid membrane, contained, in one case, a great number 
of hydatids. Thus, ten examinations of epileptics, indiscriminately made, 
presented in nine instances, lesions of the medulla spinalis, or its membranes. 
M. Mitivie, a pupil at the " Children's Hospital," found the same concretions, 
in two children who died epileptic. Who might not be tempted to conclude, 
that the organs contained in the vertebral canal, were the seat of epilepsy, 
since twelve poRt-mortem examinations of those who died epileptic had pre- 
sented some lesion of these parts ? 

A woman, fifty-three years of age, is frightened. She has convulsions, and 
remains epileptic. The attacks return every second or third day, and are 

* Ludwig. Adversaria Medico-Practica. LipsisB, 1769 — 1772, 3 vol. in 8vo. .It is in 
this collection that J. C. Greding, has published his numerous observations on the em- 
ployment of different medicines in epilepsy. * 



160 EPILEPSY. 

very violent. For some months, the attacks become more and more frequent. 
She dies at the age of fifty-six, after an attack which left her for five days in 
a comatose state. Post-mortem examination. — We found hydatids of various 
sizes, collected about the medulla oblongata, from whence they are propagat- 
ed, in great numbers, to the coxal extremity of the spinal canal, and contain- 
ed in the sac, formed by the arachnoid membrane. There is softening of the 
lumbar portion cf the medullary substance. The pituitary body, contains a 
cyst, filled with a reddish brown fluid. 

A child has had convulsions, from the time of its first dentition, which, at 
length, degenerate into epileptic attacks. At four years of age, they become 
more frequent. At the age of five years and a half, he has four or five attacks 
daily, and becomes paralytic ; dying at the age of six and a half years. At 
the post-mortem examination, the arachnoid membrane of the medulla spinalis 
was found to be injected. There was softening of the medullary substance 
near the sixth and twelfth dorsal vertebrae. The softened substance appeared 
slightly yellow. 

Musel, in dissecting two epileptics, found the spinal vessels varicose, and 
engorged with blood. Bonet has seen the spinal canal full of serum. From 
all these researches, particularly from those of Bonet, Morgagni, Baillie, Gre- 
ding, Meckel and Wenzel, what shall we conclude 1 Nothing. Wepfer and 
Lorry have drawn this sad conclusion. We confess frankly, that pathological 
anatomy, has up to this period, shed little light upon the immediate seat of 
epilepsy. However, we must not be discouraged. Nature will not always 
prove rebellious against the efforts of her investigators. 

What shall I say of the numberless reveries that have been put forth, re- 
specting the itnmediate cause of epilepsy ? The ancients attributed it to the 
influence of the moon, to the vengeance of the celestials, and to enchantments. 
Have the moderns succeeded better with their systems ? Where is the sub- 
stance that produces this nervous irritation ? Who has beheld the animal 
spirits ? Who has measured the force of their elasticity 1 They have attri- 
buted epilepsy to the Archeus, to a tumultuous and confused movement of the 
vital principle, or rational soul. Hoffmann, attributes it to the derangement 
of the course of the humors, which prevents the distribution of their spiritual 
part. Some are of the opinion, that the contraction of the dura-mater and 
envelopes of the brain and nerves, causes epilepsy. It is unnecessary to re- 
gard these reveries of the imagination. Let us pass to the diagnosis. From 
the analysis of the symptoms which characterize epilepsy, from the knowledge 
of the causes that produce it, from the lesion of the organs upon which these 
causes are supposed primarily to act, we may establish the following varieties. 
We attach moreover, to this classification no other importance than that of 
enabling us to present within a small compass, the therapeutic indications. 

Epilepsy is divided into essential, sympathetic, and symptomatic. Essential 
or idiopathic epilepsy, has its seat in the brain or its dependencies. It may 
be divided into three varieties. 

1. Idiopathic epilepsy, produced by external causes, such as too great a 
degree of compression upon the cranium, contusions, fractures, insolation. 

2. Idiopathic epilepsy, which depends upon a defect in the structure of 
the cranium, or upon a lesion of the meninges, or the brain ; upon serous or 
sanguine effusions into the cranial cavity. 

8. Idiopathic epilepsy, which we may call nervous, is produced by moral 
affections, either on the part of the mother or nurse, or on that of the patient 
himself. Among these moral causes, anger, fear and imitation, are most to 
be dreaded. 

Sympathetic epilepsy presents five varieties, clearly defined. 

1. Sympathetic epilepsy, whose seat is in the digestive apparatus. It is 
caused by the meconium, by matters accumulated in the stomach or intes- 



EPILEPSY. 161 

tines, by intestinal worms, by the indigestion of food, or substances of an irri- 
tating nature. 

2. Sympathetic angiotenic epilepsy, which has its seat in the sanguine sys- 
tem. Epilepsia plcthorica of Bonet ; Epilepsia polyposa of F. Hoffmann. 
The suppression of the menses, of hemorrhoids, and of habitual evacuations, as 
well as errors of regimen and abuse of liquors, provoke it. 

3. Sympathetic epilepsy, which has its seat in the lymphatic system ; epi- 
lepsia humoralis, metastatiea, of authors ; epilepsia cachcetica, of F. Hoff- 
mann ; epilepsia serosa, of Charles Pison ; epilepsia scorbutiea, syphilitica, of 
Bonet. Pale, chlorotic, rachitic and scrofulous subjects, are predisposed to it. 
The retrocession of tinea capitis, psora, of an ulcer, of syphilis or the gout, 
produce this variety. 

4. Sympathetic epilepsy, which has its seat in the organs of reproduction ; 
epilepsia genitalis, epilepsia ttterina, of Sennert ; epilepsia ab utero, of Jon- 
ston. The abuse of venereal pleasures, onanism, continence, pregnancy, and 
confinement, are the remote or proximate causes of it. 

5. Sympathetic epilepsy, which has its seat in the external organs ; epilep- 
sia sympathica, of authors. Every cause, whether apparent or concealed, which 
irritates any one of the external parts, and whose secondary effect irradiates 
towards the brain, produces this variety of epilepsy. 

Epilepsy is symptomatic of the cutaneous phlegmasife, of retarded denti- 
tion, of the eruption of variola, rubeola, scarlatina, etc., or of the sudden dis- 
appearance of these eruptions. With respect to that form of epilepsy, which 
is simulated or feigned, it may be caused by various motives ; for example, 
that of obtaining a thing ardently desired ; as was the case with the girl who, 
having heard that marriage was recommended for epileptics, feigned the dis- 
ease to obtain the remedy. Epilepsy is feigned, to avoid a thing which may 
be repugnant. Our young conscripts had recourse to this means. I knew an 
old officer, who had been brought before the revolutionary tril)unal, who feign- 
ed an attack of epilepsy and was saved. School-children, in order to avoid 
attending school, have also deceived their parents ; but a physician will not 
long be mistaken, if he be attentive. 

I have spoken above of the crises of epilepsy. We must say something 
of the prognosis, which is not altogether so unfavorable as' is generally sup- 
posed. Epilepsy is a long and dangerous malady, but is rarely fatal at its first 
attack. When it is hereditary and fixed, it is not cured. Sympathetic epi- 
lepsy is cured more easily than the essential form, although the latter may not 
always be incurable. Epilepsy rarely affects children who have sores upon 
the head. Sometimes epilepsy disappears for several years, to reappear, with- 
out any new appreciable cause. Those who are attacked soon after birth, are 
rarely cured. If not restored at puberty, they remain incurable. Those who 
become epileptic between the age of three, four, and ten years, are restored, 
if treated in time. Those who are seized with epilepsy, a little before the 
age of puberty, are cured when this crisis is complete. Those who become 
epileptic after the age of puberty, are sometimes cured, though Hippocrates 
may have thought otherwise. Marriage only cures genital epilepsy. It aug- 
ments the other forms. A pregnant woman who becomes epileptic, runs a 
great risk. When the attacks increase in frequency, and acquire intensity, 
we oucfht to fear death. Death takes place, not durinor the horror of the con- 
vulsions, but during the period of prostration which succeeds. 

Epilepsy, complicated with mental alienation, is never cured. The physi- 
cian, says Hippocrates, who knows by regimen, how to change the tempera- 
ment, to render it cold or warm, dry or humid, will succeed in curing epi- 
lepsy. However, there are few maladies, for which a greater number of me- 
dicaments have been proposed, or those more absurd. Some regarded only 

21 

*. ■ . • 



162 EPILEPSY. 

the condition of the alimentary canal, and prescribed evacuants ; others have 
bled ; the former desired to calm the fury of the attacks, the latter endeavor- 
ed to ffive steadiness to the inordinately impressible nerves. In fine, tonics of 
the most energetic kind have been prodigally employed. Unable to discover 
a rational tre°atment, they have sought for specifics, which have been multi- 
plied without end. The best minds, disappointed by medicine the most cele- 
brated, have regarded epilepsy as beyond the resources of medicine, and de- 
clared' it incurlible to the great detriment of the sick. Epileptics have be- 
come the prey of charlatans. If physicians had accorded to hygienic aids 
the importance which they merit, and had not preferred the exclusive use of 
medicines and drugs, they would have met with better success. 

Before entering upon the details of treatment, I will state what I have ob- 
served with respect to this disease at the Salpetriere, in the division of the 
epileptics, in whose service I was employed for ten years. I had charge of 
three hundred and eighty-five women, or girls, of every age passed puberty, 
belonging to the class of paupers. Among this number, forty-six were hyste-' 
ricalj'and three hundred and thirty-nine epileptic. The greater part, as I 
remarked page 149, were more or less habitually insane. I was no better 
satisfied with^'the description that authors have given of epilepsy, and with the 
results of post-mortem examinations which they have published, than with the 
success of the medicines which they have proposed, to combat this almost 
always rebellious malady. I wished to submit to my own observation, the 
efficacy of the most varied remedies. I employed successively, sanguine eva- 
cuations and purgatives, baths of every temperature, issues, the cautery, fire, 
and antispasmodics, vegetable and mineral. I confined myself to hydrocy- 
anic acid. I procured and purchased secret remedies. Every spring and 
autumn, I chose thirty epileptic women, with the history of whose malady I 
was best acquainted ; its causes and symptoms. The women were prepared 
in advance, by repeated promises of a certain cure. I was very much assist- 
ed by the watchfulness of the pupils. 

A new medicine invariably suspended the attacks with some, for fifteen 
days ; for a month, two months, and even for three months, with others. Af- 
ter this period, they returned, presenting in every case the same characters that 
they had done in preceding years. Several of our epileptics submitted them- 
selves to my treatment for several years ; but, shall I confess it ! I did not 
obtain a single cure. In my private practice, I was scarcely more happy. If 
the attacks were suspended, it was less by the action of medicines, than the 
effect of the confidence which determines a patient to consult a new physi- 
cian. Is not this remission or suspension, generally observed by physicians 
who are called to treat chronic diseases, particularly those called nervous ? 

Ere long I perceived that epilepsy is rarely curable. It has happened that 
cures of hysteria have been published, which were supposed to be epilepsy. 
The mistake is easy, so greatly does the latter malady resemble epileptiform 
hysteria. Authors have also taken for a cure, the spontaneous suspension of 
the attacks, as well as their suspension from every new mode of medication. 
This error is the more readily committed, as the patients are lost sight of, by 
the physician, who is not consulted on the return of the attack. The follow- 
ing case will justify my suspicions respecting the cure of epilepsy, and put us 
on our guard against precipitancy in our judgment. 

When I assumed the duties of a medical officer at the Salpetriere, Doctor 
Landre-Beauvais, who had preceded me in charge of this department, handed 
me notes of those cases which he had submitted to a particular treatment. 
At this period, the strongest confidence was placed in the efficacy of the ni- 
trate of silver. My colleague had made trial of it, and remitted to me the 
following note respecting N. She has employed the Nitrate of Silver, for a 



EPILEPSY. 163 

long time, and has had no attack for six months. Her menses, which uiere 
suppressed, are reestablished. Six months pass away, and N. demands a dis- 
charge from the hospital, because she has been restored for a year and is now 
very well. Before making out a certificate of discharge, required by the 
regulations of the hospital, I addressed several questions to her respecting the 
causes of her malady and cure. In her reply, she made the following disclo- 
sures. " Jealousy and mortification suppressed the menstrual discharge, and 
I was immediately seized with an attack. I was admitted into the hospital, 
and many remedies were employed. M. Landre-Beauvais ordered me pills of 
silver, and I took them for several weeks. Finding myself no better, I laid 
them aside. I said nothing about it, through fear of grieving M. Beauvais, 
who was very kind to us. Sometime after, a woman in the hospital gave me 
a very strong ptisan, in order to bring about a return of the menses. She 
succeeded. The attacks of epilepsy have not appeared for a year. My "pe- 
riods" are regular and abundant. I no longer have attacks nor vertisfoes. I 
am quite well, and am going to return to the house of my master." Two 
months after her discharge, she comes to solicit a readrnission to the hospital 
as the attacks had reappeared. The nitrate had not cured the patient. Thus 
my confrere, an equally good observer and judicious practitioner, contented 
himself with recording in his notes ; " N. has made use of the nitrate of 
silver, and her menses have been restored for six months, since which period 
she has had no attacks," He does not add, " N. is cured." 

This fact among a thousand, proves how distrustful we should be, respect- 
ing the administration and effects of medicines ; and with how much reserve 
we should proclaim the cure of a malady, especially of a malady of the ner- 
vous system. To treat epilepsy, we must not only attack the cause, but re- 
move the disposition to a return of the attacks. We must prevent the attacks 
when they announce themselves by precursory signs, and avoid the accidental 
causes which may provoke them. The best practitioners are of the opinion 
that nothing is to be done during the attack, but precautions must be taken, 
lest the patient injure himself If we have given some attention to the symp- 
toms calculated to reveal the cause of epilepsy, and the organ upon which this 
cause primarily acts, we shall have presented to us the principles of treatment, 
which are suited, not to epilepsy in general, but to each species or variety in 
particular. 

Thus, epilepsy which has its seat in the digestive system, should be treated, 
if there is gastric embarrassment, by emetics and purgatives, selected from 
among those which do not debilitate. Galen employed the oxymel of squills 
with the greatest success. If there is irritation, we prescribe sanguine evacu- 
ations and sedatives. The Artemesia Santonica and Calomel, are employed 
when worms infest the alimentary canal. The mineral waters of Balaruc, of 
Spa and of Pyrmont have been found useful.* The patient should avoid 
every thing that can surcharge the stomach, such as greasy substances, butter, 
and salted food. If we suspect some engorgement of the liver, whey with 
cream of tartar, the mineral acids, particularly the sulphuric, are recommend- 
ed, as well as the Cichorium Intybus [Succory), Saponaria officinalis, and tepid 
baths These means, which the discretion of the physician must modify, should 
be combined with tonics, Peruvian bark. Valerian, etc. 

Epilepsy, which has its seat in the sanguine system, ought to be combated 
on other therapeutic principles. If there is plethora, attended with cerebral 
congestion, general blood-letting, repeated if necessary, cups, and leeches ap- 
plied to the temples or behind the ears, particularly among children, are use- 
ful. We recall suppressed sanguine evacuations, whether normal or patholo- 
gical. If puberty, or the first appearance of the menses does not remove the 

* See Hooper's Med. Dictionary, article Mineral Waters. 



164 EPILEPSY. 

disease, it should be treated like essential epilepsy. If menstrual disorders 
are the effect of epilepsy, we should fear exasperating the evil by the persever- 
ing administration of cmmenagogues. We shall avoid error, if, returning to 
earliest infancy, we discover the first indications of epilepsy, that is, convul- 
sions, or incomplete attacks. As it respects regimen, we insist upon the 
means proper to moderate the activity of the circulation ; to prevent its too 
strong impulse towards the head, and to render sanguification less active. 
Insolation, large assemblies in warm and imperfectly ventilated apartments, 
violent exercises, liquors, and the violent passions, should be avoided, and also 
constipation. Epilepsy, which has its seat in the lymphatic and absorbent sys- 
tem, and which is produced by the suppression of the transpiration, or an 
ulcer, the retrocession of psora, herpes or the gout, requires a treatment 
adapted to reestablish these various affections. It is with this view, that it has 
been recommended to dwell in cow stables, in cases of epilepsy that have been 
produced by the suppression of the transpiration. M. Landre-Beauvais, with 
reference to this suggestion, directed the following experiment to be made at 
the hospital of the Salpetriere. Four beds were placed in the stable, in which 
four cows were kept. Four young epileptics occupied this stable for several 
months, and were replaced by others. The result was absolutely null. 

Does difference of^ climate and regimen, explain why this means has suc- 
ceeded elsewhere, while it has been unsuccessful with us ? Finally, we un- 
derstand that a treatment, suited to reestablish tlie transpiration, would be 
favorable in that form of epilepsy, which is caused by the suppression of this 
function. Thus, tepid baths, frictions, moderate exercise in the open air, etc., 
would be useful. Issues have succeeded, when we have wished to produce a 
derivative irritation, or have desired to replace a cutaneous affection, an ulcer, 
tinea capitis, or tetter. Exutories upon a large surface, ought to be continued 
for a long time, even after a cure has been effected. Epilepsy, which has its 
seat in the organs of reproduction, offers numerous considerations which ought 
to control our treatment. If epilepsy is produced by the constitutional effort 
that takes place at the age of puberty, the patient requires a good regimen 
and exercise ; gymnastics and the cold bath, are not to be neglected. If it is 
suppression of the menses, or menstrual disorder which has produced epilepsy, 
we must reestablish or regulate this evacuation, and if the constitution of the 
patient is strong, and we have reason to suppose that atony of the organs of 
reproduction exists, marriage may be advised. By reestablishing an equilibrium 
in the distribution of the vital forces, epilepsy will cease. But we must not 
lose sight of the fact, that often, the suppression of the menses is not the 
cause of epilepsy ; tliat the true cause acts sometimes from earliest infancy, 
especially in hereditary, or constitutional epilepsy, and in the case of children 
committed to the care of mercenary nurses or strangers. If onanism has 
been the cause of this frightful malady, we must have recourse to all those 
means which can, so to speak, renew the temperament. Bark, valerian, the 
martial preparations, asses' milk, a diet of white meats, and analeptics gene- 
rally, are serviceable. Corporeal exercises, on horseback, by fencing, dancing, 
cold baths, river baths, swimming and affusions, often so useful, would be 
dangerous, if there existed engorgements, or suppuration in the viscera. 

The different examples which we have given above, furnish to the practi- 
tioner some special indications. If the cause, which acts primarily upon an 
oro-an, is easily removed or destroyed, we eradicate it. We apply fire, caus- 
tics, setons or cupping glasses, over the part from whence the aura cpileptica 
proceeds. It has been proposed even to divide the nerves. Antispasmodics 
and reorimen, ought to second the local means. Can idiopathic epilepsy be 
cured, if it depend upon an organic lesion, or upon a vice of conformation? 
What are we to expect from medicines? The physician who is a wise obser- 



EPILEPSY. 165 

ver, avoids the use of them, and confines himself to regulating the regimen, 
and shunning those circumstances which are calculated to produce a return 
of the attacks. The cautery, moxa, and the trephine have been recommend- 
ed, when the recollection, and a fixed pain in the head, lead us to hope to 
reach the cause of the evil, or when the symptoms indicate infiltration of the 
brain or its meninges, by serum, or, as the ancients would say, by phlegm. 

The prince of , epileptic from his earliest youth, would permit no one 

to approach him, notwithstanding the entreaties of his family. With the pro- 
gress of age, the attacks became more frequent ; and at fifty-seven years of 
age, he is taken with an attack and falls headlong into the fire. After havino- 
burned through the scalp, the fire penetrates even to the external table of the 
parietal bone. An abundant suppuration is established, and the wound is kept 
open by a portion of necrosed bone. The sick man, having become impa- 
tient, demands the service of a surgeon, who removes the bony fragment, and 
cicatrization advances rapidly. It is complete in the space of forty-two days. 
During all this period, the patient had no attack ; but they immediately re- 
turned after the cure of the wound. One of them is followed by mania with 
fury. Two large bleedings control the delirium. At a numerous consulta- 
tion, I proposed to open the woimd with the actual cautery. Those composino- 
the consultation, preferred two issues in the neck. These produced no effect. 
I have ever since regretted, that my advice in the case had not been reo-ard- 
ed. Valentin cites the cases of epileptics, who have been cured, by the ac- 
tual cautery applied to the head. 

[As illustrative of the efl'cct of powerful and long continued counter-irritation in the 
treatment of Epilepsy, I would state the following case : A. W. S., a young man, now 19 
years of age, has been subject to epileptic paroxysms, gradually increasing in frequen- 
cy ever since his tenth year. His first attack occurred within an hour after eating, ad 
libitum, of almonds and raisins. It was on an anniversary occasion, when the largest 
liberty is usually extended to children, and the energies of both mind and body are taxed to 
the utmost. Being the only member of a large family who had ever been seriously 
ill, this dreadful occurrence excited the liveliest sympathy. The attacks continued to re- 
cur, notwithstanding every effort that a father's tenderness and the skill of the most able 
physicians, could suggest. So trying to the feelings of the iemale members of the family 
were his paroxysms, and such their efi'ect upon the mind of the patient, that he was at 
length placed at the Retreat at Hartford, Conn. In this Institution, during a period of 
nearly four years, he was submitted to every variety of treatment, both moral and medi- 
cal, that offered the smallest prospect of relief, but without success. In the month of 
December, 1843, his attendant rose as usual at an early hour in the morning, built a fire 
in his stove — the pipe of which was carried up a few feet, then returned, and after being 
brought near the floor, by an angle conveyed into the flue — and left the room for a few 
moments to procure a pitcher of water. During his absence the patient arose, went to 
the stove, and, — feeling an unpleasant sensation in his head, — leaned forward over the 
pipe, to bathe it in a basin of water which stood on the other side. At that moment he 
was seized with a paroxysm, and fell with his abdomen directly across the heated pipe, 
from which it was protected only by a thin surface of cotton cloth. He was heard to 
fall by a person occupying the room beneath, who immediately ran to his assistance, but 
not before a frightful burn had taken place. A deep, suppurating wound, embracing 
nearly the entire surface of the abdomen, confined him to his bed for several months, 
reducing the system excessively, and for many weeks threatening his life. He at length 
however recovered, and has never had an attack, (now almost eleven months), since 
that connected with the injury just described. He is still cautious with respect to regi- 
men, avoiding sources of much excitement, and confining himself mainly to farinaceous 



166 EPILEPSY. 

and vegetable food. He reads however, studies, and submits himself often to influences 
which formerly resulted uniformly in a fit. 

How long this reprieve will last, — if it be a reprieve merely, — time alone will show. 
Though perhaps practically of little utility — as this agent, to a similar extent will never 
be resorted to as a remedy — it furnishes still further evidence that the causes of epilepsy 
are deeply seated, and that the severest shock to the whole system, compatible with life, 
can alone be expected to be attended with salutary and permanent results. It may be 
proper to add, that this patient was bled several limes during the early part of his treat- 
ment, took purgatives at brief intervals, had a seton open for many months in his neck, 
was put upon a rigidly abstemious diet, avoiding meats, stimulants, and indigestible food, 
and had recourse to gentle exercise. By one physician, with whom he spent a conside- 
rable period, the Nitrate of Silver was employed freely. After his admission at the Re- 
treat, the seton was continued for a time, and a restricted regimen enjoined. Part of the 
time, exercise in the country was permitted ; and at other periods, in order to avoid 
mental excitement, he was confined to his room. At his own urgent solicitation, he was 
kept in his room for three successive months, and limited to a tea-cupful of mush and 
milk three times a day, during the whole period. During this time, his mind was in a 
calm and cheerful frame, and an interval of seven weeks elapsed between the parox- 
ysms. The records show that he took Hydrocyanic Acid for about three months — from 
one to three drops at a dose — thrice a day. The shower bath was administered twice a 
week for many months. He was put upon full doses of the Sulphate and Oxyd of Zinc, 
the Exts. of Strammonium and Belladonna, — took Valerian and Ammoniated Copper — 
his bowels being kept free, sometimes by salines, sometimes by drastics, and at others by 
laxatives. From none of these agents was any benefit received, and but brief and tem- 
porary amelioration of any of the symptoms. A very abstemious diet rendered the inter- 
vals between the fits longer than anything else, and also made him more pleasant. It 
has always been observed, that if he ate heartily, or partook of fruit, or of a variety of 
food, it made him worse. Medicine was suspended and renewed at intervals, but with 
little benefit; and at the time of his accident, no expectation of his recovery was enter- 
tained. He now takes Quinise Sulphat gr. 1, Morphia? Sulphat gr. 1-8 in Camphor mix- 
ture, three times a day. Diet limited to vegetable and farinaceous food, in moderate 
quantity.]* 

Henricus ab Heers, cites the example of a girl who, near the time of her 
marriage, was frightened by two men in a state of intoxication, who endeavor- 
ed to violate her. Muriate of Antimony, applied to the great toe of either 
foot, until the bone was denuded, terminated the attacks. When our eloquent 
and learned Pariset, then physician at the Bicetre, was sent to Cadiz, to inves- 
tigate the yellow fever, I was charged with the service of the insane and epi- 
leptics in that ho.spital. I found twenty epileptics submitted to the experi- 
ments of my professional brother. Moxas, to the number of two and even 
three, had been burned upon the most elevated part of the head, and the ustipn 
had penetrated even to the external table of the bones. The wounds were 
kept open with the greatest care. I could not furnish undeniable proof of a 
single cure. There was brought to the Salpetriere, a young epileptic whose 
attacks began in the great toe. On the faith of authors, I believed the cure 
certain. The toe was cauterized to the bone. Far from having cured my 
young patient, the attacks were no longer announced by pain in the great toe ; 
there was no longer an epileptic aura; but they were both more frequent and 
violent. Finally, essential epilepsy ought to call into exercise all the attention 

* This patient, I have just learned, returned to his father's family a little more than a 
year after liis last attack at the Retreat, but was seized with a fit about four days after 
his return. 



EPILEPSY. 167 

of the practitioner. It is against this form, as it occurs among children, that 
we have sometimes employed with success, valerian, bark, iron, the misletoe 
of the oak, (Viscum album) musk, opium, camphor, assafcetida, mercury, etc. 
Let us examine briefly, the importance of these substances, and fix the degree 
of confidence which they respectively merit. 

Valerian is one of the medicines, whose reputation is most generally ad- 
mitted. There is no practitioner who has not congratulated himself upon the 
use of it. Its decoction is feeble and unpleasant to the taste. We give it in 
substance, in the dose of from one to two ounces a day, in powder or extract. 

[The quantity of Valerian here recommended, greatly exceeds the dose usually em 
ployed. From one half a drachm, to a drachm three or four times a day, would gene- 
rally be regarded as a full dose, and as much as could well be borne.] 

The peony, (Paeonia ofiicinalis), is worthy of no confidence. The misletoe 
of the oak, has been employed by those entertaining superstitious views, with 
more benefit. It is now abandoned. Musk, so useful in certain ataxic fevers 
and convulsions, has been useful, but would be injurious in plethoric epilepsy. 
The same is true of opium, whose employment requires much prudence, al- 
though it may have succeeded in essential epilepsy, caused by moral affec- 
tions ; in epilepsy sympathetic of very violent local pains, and in nocturnal 
epilepsy. Bark, and the leaves of the orange-tree in substance, are useful ; 
camphor and assafcetida have had their admirers. Iron is preferable to bark, 
in debilitated and chlorotic cases, when it is particularly desirable to stimu- 
late the circulation. Mercurial frictions have been proposed, to combat epi- 
lepsy consecutive to syphilis. Calomel is recommended, not to combat a 
particular infection, but to change the general action of organs, and to in- 
crease the activity of the functions of the lymphatic system. Thouret and 
Andry* assure us, that they have sometimes obtained happy effects from the 
application of artificial magnets. In England, they have tried the inhalation 
of a mixture of oxygen gas and atmospheric air. Their success has been 
more than uncertain. These various experiments, merit the careful attention 
of observers. I hesitate about saying so much respecting electricity and gal- 
vanism. 

Shall we give the name of medicines to those substances, whose employ- 
ment would appear incredible to those who know not to what degree of de- 
gradation man can descend, when given over to ignorance and prejudice ? 
Will it be believed that physicians have prescribed earth worms, siccdloioed 
fasting; the powder of an elk's foot, the heel of a hare, the after-birth of a 
first horn dried; the scrapings of a human skull, and the vertebrae; besides 
the dried brain of a man and raven 1 They have prescribed human blood 
warm, the little bones of the ear of a calf, the back bone of a lizard stripped 
of its flesh hy ants, the heart and liver of a mole, of a frog, and of many other 
substances, more or less disffU-stinff and absurd. Will it be believed, that in 
our day, it has been proposed to insert an amethyst beneath the skin of the 
arm or some other member, as an infallible specific? Without wishing to 
rank the metallic salts in this revolting enumeration, I think that they ought to 
be proscribed. Is their use serviceable 1 The perturbation which they pro- 
duce in the organism, and upon which is founded the hope of cure, is too 
hazardous and often too serious, especially if employed by rash or unskillful 
hands. Thus we reject as dangerous, the salts of copper and jiitrate of silver, 

* A. Portal, in his work (Observations on the Kature and Treatment of Epilepsy, Paris, 
1827, in 8 vo.), has gone largely into details, respecting the various medicines proposed 
for the cure of epilepsy. 



168 EPILEPSY. 

how many miracles soever may be attributed to their use. We can say as 
much of fear, which is recommended by some rash persons. But who can 
calculate the effects of fear, and consequently, who would dare to make use 
of it as a curative ao-ent ! 

It is essentially to hygienic influences, that we must have recourse m com- 
bating epilepsy. They are of indispensable application, to renew, in some sort, 
the constitution of the sick. By these means they will be permitted to engage 
in the cultivation of the soil, in exercise on horseback, and in gymnastics, 
dancing, swimming and fencing. Hippocrates recommends change of coun- 
try. Van-Swieten has seen many epileptics, who had no attacks during their 
residence in the East Indies. Marin cites the example of a girl, who prevent- 
ed the attacks by music. I knew one whose attacks occurred during her first 
sleep, and who often prevented them, by retiring at a late hour, and by yield- 
ing herself to gentle and agreeable diversions, before retiring for the night. 

These latter considerations, call to mind what has been said about prevent- 
ing the attacks. In sympathetic epilepsy, we sometimes prevent the attacks, 
by causing the patient to walk about rapidly, the moment the first symptoms 
manifest themselves, by extending, powerfully, the limb from whence the first 
sensation of an approaching attack, or the epileptic aura proceeds, by applying 
ligatures above the part primitively affected, and by removing all physical and 
moral causes, which provoke the return of an attack. Pinel employed the 
inhalation of ammonia, as soon as the epileptic experienced the first indica- 
tions of a seizure. It remains for me to say a word respecting the precautions 
which it is proper to take, to prevent the unpleasant consequences of epilepsy. 
The prostration of the physical energies, requires, in general, strengthening 
regimen. We must dispel the false shame which grieves and discourages epi- 
leptics, and remove the prejudices vyhich cause them to be regarded with a 
sort of dread. The habitual sadness in which many of them live, aggravates 
their condition. We should watch over their actions and conduct. Strongly 
inclined to the pleasures of love, they give themselves up to the practice of 
solitary vices, which are more injurious than the evil itself We shall avoid 
the consequences of falls, by selecting habitations on a level with the ground, 
by providing the epileptics with attendants, who will hold them up when about 
to fall, and lay them down upon a bed or the ground, guarding their heads 
from hard substances, against which they might otherwise injure themselves 
durincr the convulsions. In their various movements, we must be careful not 
to restrain them, by confining the members tightly. In order to avoid cuttmg 
the tongue, or breaking the teeth, some of these patients exercise the precau- 
tion of placing a roll of linen between the teeth; and I knew one lady who 
never retired to bed without taking this precaution. If the attack takes place 
during the night, we may wad the bed, giving it the form of a box, to avoid 
falls. Where many epileptics are assembled together, we shall avoid many 
accidents, by placing them in dormitories, on a planked ground floor, and in 
employing very low beds. They ought not to live together in the same wards 
with the insane, as is practiced in most hospitals where they receive both these 
classes of patients. The sight of an epileptic seizure, is sufficient to render 
a well person epileptic. How much greater is the danger, in the cure of an 
insane person, often so impressible ! What shall we think of the indifference 
with which these unfortunates, whom we meet in the public way, are permit- 
ted to wander about, who never fail to draw around them a crowd of the curi- 
ous, embracing both women and children ? Nevertheless, the sight of an epi- 
leptic seizure, is* sufficient to produce epilepsy. These unhappy people, muti- 
lated, often covered with blood, and always indigent, excite commiseration, 
and obtain charity from all beholders ; and there is no doubt, that rogues have 
recourse to this means of obtaining money from the passers by. It is well to 



EPILEPSY. 169 

point out this abuse, so much the more reprehensible, as it serves as a pretext for 
rocruery, by compromising the health of citizens. I remarked in commencing 
this article, that at the onset of the attacks, epileptics are thrown either upon 
the back or abdomen. In the latter case, they bruise themselves and disfigure 
the countenance. We see some of them whose faces are marred by the cica- 
trices of burns which have been produced by falling into the fire. Worse re- 
sults may happen. When the attacks take place during sleep at night, some 
epileptics turn upon the face in bed, and if not succored, when the collapse 
takes place, the face presses upon the bolsters or pillows, and asphyxia termi- 
nates the existence of the patient. We cannot guard with too much care, 
those epileptics who have nocturnal attacks, especially those who, during the 
convulsions, are thrown upon the face. 

The case which I am about to relate, and with which I shall finish what I 
have to say respecting epilepsy, is calculated to give us an idea of the epileptic 
state. The subject is a patient who has, in all his habits of body, an impress 
of the malady to which he is a victim. It was obtained by M. Leuret, physi- 
cian of the hospital of the Bicetre. 

" Joseph B , now an epileptic, and deformed by the contractions of his 

limbs, was formerly a drummer in a regiment of the line. Like many sol- 
diers, he became intoxicated, whenever opportunity offered. On those occa- 
sions, he was in the habit of quarreling, and it was after a quarrel which took 
place during a fit of intoxication, that he experienced his first attack. He 
does not know whether any member of his family was ever affected by this 
malady, or any other nervous affection. He is now forty-seven years of age, 
and was twenty-eight when seized with his first attack. He has therefore suf- 
fered from this malady nineteen years. Without fortune, and unable by his 
labor either to satisfy his necessary wants, or to secure proper care, he is ad- 
mitted at the Bicetre. For a long time, his attacks were quite slight, and per- 
mitted him to render himself serviceable in the hospital. He was employed 
as a glazier. Eight years after his admission, whilst laboring at his vocation 
in the fifth story, the cord which sustained the scaffold upon which he was sit- 
ting, broke, and the unfortunate Joseph B. fell upon the pavement, and was 
wounded in the head. From this moment, his attacks, which were previously 
very frequent, became more so, and his body was reduced to a state of gene- 
ral and permanent contraction. He almost always lies upon his back, his feet 
rigid and inflexible, the legs drawn up towards the thighs, the hands flexed 
upon the fore-arms, and the latter upon the arms ; in a word, the members 
are so stiffened, especially those of the right side, as to be scarcely capable of 
executing any voluntary movement. Sensibility is changed in an analogous 
manner. The left side still feels. Touch is still exercised there in a slight 
degree, and it transmits, although feebly, the impression of cold or heat. On 
the right side, sensibility is almost gone. We touch the arm or thigh of this 
side, but the patient does not perceive it. We pinch him, without producing 
any pain. In front, upon the trunk, the line of demarkation between the two 
sides, is well drawn. Insensibility ceases at the linea alba on the abdomen, 
and at the median line on the chest. Posteriorly, it is along the middle of the 
back. The head is usually drawn back, and the muscles of his person, even 
when in a state of repose, (which rarely occurs), leave upon the features a 
convulsive expression. 

He is incapable of making a regular and complete movement, and if he 
wishes to lay hold of any thing with his left hand, which is the better of the 
two, he never succeeds at the first effort, nor without fatigue. If he desires 
to speak, the tongue stammers ; he pronounces one or two syllables, and una- 
ble to finish, seeks an equivalent for the word which his tongue refuses to ar- 
ticulate, This defect gives to his speech a great resemblance to that of a 
drunken man. Rarely are his muscles in a state of complete repose. If their 

oo 



170 EPILEPSY. 

contractions are too feeble to execute certain movements of those parts which 
it is their office to move, by applying the hand upon any part of the surface 
of the body, we feel that it is agitated by a kind of vermicular movement, very 
analogous to what occurs in ataxic fevers, and which are called snbsultus 
tendinum. If he closes his eyelids, we observe that they tremble. For more 
than seven years, that is, after the disappearance of the immediate symptoms 
caused by his fall, he has daily from three to six epileptic attacks. A little 
less than a minute before the attack, he is apprised of its approach hy some- 
thing tohich takes place in his head; utters a cry, mutters certain words, and 
loses his consciousness, at the same time that he experiences epileptic contrac- 
tions. It is rare that saliva issues from his mouth. The attack lasts for a 
short time, and the patient promptly recovers his senses. 

Notwithstanding the long duration of his malady (nineteen years), and the 
frequency of the attacks, the understanding of the patient preserves its origi- 
nal integrity. His words are not always intelligible ; indeed, they lack much 
of it. His phrases are never complete, nor is the expression of his features 
ever in relation with what he is saying; but it is easy to see, that all this de- 
pends upon the instrument which executes his will. That sentence, which a 
convulsive movement does not prevent him from expressing, denotes a just 
thought, and a healthy judgment. With respect to his moral manifestations, 
he is superior to the greater part of his companions in misfortune, who are 
otherwise less afflicted than himself Epilepsy changes the character, and dis- 
poses the unfortunate subject of it, to bickerings and freaks of violent anger. 
Joseph B., however, is very mild, taking notice of the attentions that are paid 
him, and when any one approaches him, he sees that he is always disposed to 
smile, or to utter expressions of thankfulness. The functions of nutritive life 
are healthfully executed ; the appetite is good, alvine evacuations take place 
daily, and the urine is excreted as in a state of health. The pupils contract 
properly ; and the respiration and pulse offer nothing anormal. There are 
doubtless, few examples of a malady as long, and of attacks as numerous and 
frequent, in which the intelligence has remained so sound, as in the case of 
Joseph B. It is the only case that I have ever met with, among more than 
six hundred epileptics." 

[Witli respect to the pathology of Epilepsy, the views of our author correspond with 
those of the profession who liave most carefully investigated the subject in this country 
and in Europe. We can add nothing to what lias been stated respecting tlie Idiopathic 
form of this malady, and shall content ourselves with a few remarks in reference to his 
other division, or Sympathetic Epilepsy. 

Wiiile we frankly admit that we have little confidence in the efficacy of remedies in 
this disease, we cannot find it in our hearts to recommend an entire disuse of them. We 
believe that wlien judiciously employed, tiiey may aid the Vis Medicatrix in its efforts to 
repel those morbid influences that so seriously disturb the functions of organic life. It 
becomes us to study with care the pathology of every case that is presented to our no- 
tice, and to relieve, so far as practicable, every disordered action. To overcome nervous 
irritability, to equalize the circulation, to regulate the secretory functions, and to secure 
a calm and hopeful frame of mind, will clearly constitute a part, and that not an unim- 
portant one, of our duty. Certain agents belonging to the class of Sedatives, combined 
with those which are known to exercise a tonic influence, may be employed, with a 
view to their supposed specific influence, the quantity of their respective ingredients 
varying, to meet the indications which are from time to time presented. Tlic prepara- 
tions of Copper and the Witrate of Silver, are those articles of ilie latter class upon 
which reliance may be placed ; and Camphor, the Extract of Belladonna, and Strammo- 
nium in some of its forms, of the former. To these. Valerian and Assafcetida may per- 
haps be occasionally added, with advantage. We notice these remedies, among many 



EPILEPSY. 171 

that occur to us, not so much because we entertain a greater degree of confidence in 
them, but rather because they are at present the more popuhu". Every source of irrita- 
tion which may originate in the use of indigestible food, from intestinal torpor, or from 
an inordinate amount of alimentary matter in itself proper, all mental agitation, whether 
from the exercise of pleasing or depressing emotions, and such corporeal exercises or 
occupations as are sedentary, or require for their performance a stooping posture, are to 
be scrupulously avoided. In a word, all the means employed should have for their ulti- 
mate purpose the restoration of every disordered function, and the preservation of the 
integrity of every portion of the system.] 



CRITICAL TEEMINATIONS OP INSANITY. 



General remarks on the doctrine of crises. — No cure without a crisis. — Causes of incom- 
pleteness of crises. — The physician the minister of nature. — Remarks on relapses. — 
A marked remission usually during the first month. — Its cause. — Insanity terminates 
by resolution. — Principle of cure illustrated by cases. — Terminates by the predomi- 
nance of activity in the absorbent system. — Terminates by great prostration and ema- 
ciation. — Example. — A febrile movement often serviceable. — Examples. — Hemor- 
rhages sometimes effect a cure. — Examples. — Herpetic eruptions sometimes cure insa- 
nity. — Examples. — Furuncles sometimes critical in insanity. — Examples. — Abundant 
suppurations, whether spontaneous or provoked, sometimes terminate insanity. — A 
variety of illustrations and examples. — Influence of coition and continence. — Exam- 
ples. — Pregnancy and confinement sometimes terminate insanity. — Examples. — Preg- 
nancy and confinement, when they effect a cure, act rather as exceptions than in ac- 
cordance with a general rule. — Dentition as a cause of insanity. — Examples. — Crises 
of insanity arranged in their order. 

I SHALL not discuss all that has been said respecting crises, nor sit, a self- 
appointed judge, upon the respective merits of Galen and Asclepiades. It is 
sufficient for me to remember that the doctrine of crises is as ancient as ob- 
servation in medicine ; and that, divested of pythagorean notions, and the 
subtilties of dogmatists, it has been sanctioned by the experience of all ages. 
I propose to demonstrate that this doctrine is, in all respects, applicable to 
mental diseases. This application would be far more fruitful with respect to 
therapeutics, should I extend it to each order of the vesanise. But the crises 
of insanity having been imperfectly understood, or neglected by the greater 
part of authors, I have desired to point them out in this essay, as furnishing 
useful hints for the treatment of this malady. 

Mental alienation, which the ancients regarded as an inspiration or punish- 
ment of the gods ; which was afterwards regarded as a demoniacal possession, 
and which, in other times, passed for the work of magic; mental alienation, 
in all its forms, and varieties innumerable, differs in no respect from other 
diseases. Like them, it has its premonitory symptoms, which enable us to 
foresee it, symptoms which characterize it, a course which is proper to it, 
periods of increase and decline, a duration peculiar to it, and at length, the 
united efforts of the whole system, tending to terminate it, either by a cure, 
or by death. Like all maladies, insanity is sporadic or epidemic, hereditary 
or accidental, idiopathic or symptomatic. It is simple or complicated ; con- 
tinued, remittent, or intermittent ; acute or chronic. Why should not insa- 



174 CRITICAL TERMINATIONS OF INSANITY. 

nity terminate by crises 1 Hippocrates, and all good observers assure us, that 
the cure of diseases never takes place without critical phenomena. In fact, 
where is the physician who, having prescribed for a patient, would believe him 
to be effectually cured, unless lie could refer, in his own mind, to crises which 
terminated the disease 1 Doubtless, there are forms of disease, in which cri- 
ses are especially frequent, and easily perceived. Such are acute diseases. 
It is very unusual, that in grave forms of fever, and in the phlegmasiae, we 
do not observe critical phenomena. Now, insanity presents the most striking 
analogy to these disorders. The points of resemblance are so numerous, that 
often, at the period of attack, the most skillful eye can scarcely distinguish 
them. This analogy becomes still more surprising, when we compare certain 
insane persons with the dying. We notice among them, almost all the signs 
of death described by Hippocrates ; — the eyes fixed and glaring, with a look 
still more terrible, which seems to discover from afar, some frightful object ; 
a sinister and mysterious air ; convulsions of the hands, or carphologia, altera- 
tion of the voice, a sardonic laugh, involuntary dejections, etc. With rela- 
tions so striking between insanity and those maladies which terminate most 
frequently by sensible crises, why should not the former itself terminate by 
crises 1 

1 have always observed, that the cure of mental maladies is only deceitful 
or temporary, when it is not determined by some critical phenomena. At- 
tacks of intermittent insanity terminate, almost invariably, promptly and sud- 
denly, without enabling the physician to perceive the critical cause of the 
cessation of the symptoms. I say almost always; because it happens that the 
attacks, especially when their return is regular, terminate by crises as constant 
and regular, as the epoch of the return of the attacks themselves. In chronic 
insanity, the crises are less apparent, because the symptoms are less energetic, 
and more tardy, because the symptoms proceed slowly. They are more sud- 
den and marked, in accidental and acute attacks of insanity, which seize, 
with violence, young, strong, and robust subjects. The crises are incomplete. 
Hence the reason why mental alienation is, in these cases, often chronic. 
When we reflect that causes the most debilitating, both physical and moral, 
are those which, in a great majority of cases, predispose to this malady, and pro- 
voke it ; it furnishes a very satisfactory explanation, of the defective reaction, 
the incompleteness of the crises, and the transition of insanity to the chronic 
state. Those whom insanity attacks, are debilitated by excessive study and 
watchfulness, by the abuse of pleasures, by long continued griefs ; by every 
variety of error in regimen, by acute disease, by habitual evacuations. If the 
early symptoms indicate a good degree of constitutional vigor, this energy is 
only apparent and deceptive, and becomes the source of many errors in treat- 
ment. 

Another cause of the incompleteness of crises, and consequently of the 
chronic nature of insanity is, that it is a malady, in which the critical efforts 
are especially affected by nervous anomalies, and by the excessive sensibility 
of the patients ; circumstances which, by interfering with the regularity of 
the vital movements, powerfully oppose the completeness of the crises. Nor 
must we lose sight of the fatal effects of the treatment employed at the com- 
mencement of insanity. Frightened by the first symptoms, they almost de- 
stroy the patient, by copious and repeated bleedings ; and thus deprive nature 
of that vital energy, which is necessary to bring the malady to a successful 
termination. These agitators are ignorant of the fact, that the physician does 
not cure ; that he is only the minister of nature, that his office is, to remove 
the obstacles that might otherwise turn her aside from her proper path, and to 
prepare the patient for the successive development of the symptoms of the 
disease, so that he may prove equal to the critical efforts that are to terminate 
it. Meanwhile, Hippocrates advises us to be watchful at the beginning of 



CRITICAL TERMINATIONS OF INSANITY. 175 

disease ; and warns us not to be frightened by the grave symptoms, whicli 
precede and accompany crises. 

What shall we think of those physicians, who always wish to have a share 
in whatever nature does, who are armed at all points, to combat one after the 
other, and, as it were, hand to hand, the symptoms that occur during an at- 
tack of disease 1 Let them call to mind this fearful sentiment of Baglivi ; 
Quanto pliires remedionun usus necat, qudm vis et impetus morhi. [De crisi et 
diebus c?-iticis). A comparison of the existing method of treating the insane, 
with that employed by the ancients, proves this. Desiring to abate the acti- 
vity of the vital forces, they deprived the maniacs of that energy which was 
necessary for delirium. Hence, sudden deaths, paralysis, and dementia. 
Hence, temporary cures, followed immediately by relapses, when reaction per- 
mitted the development of the first symptoms. Thanks to the principles set 
forth by Pinel, we find at this day, a wise custom prevailing, which watches 
the efforts of nature, in order to second, not to prevent them. 

It is also certain, that in our days, we cure a greater number of the insane, 
and that relapses are less frequent than formerly. We should carefully guard 
against confounding relapses with new attacks of insanity. All physicians 
know, that individuals who have suflered from intermittent fevers, from inflam- 
mations of the brain, of the lungs, stomach, etc., are, more than others, ex- 
posed to contract again these same affections ; since an organ, that has once 
been affected, is, from this circumstance, disposed, more than another, to be 
aflfected anew. We do not give the name of relapse, to the returns of other 
diseases, and why should we to a new attack of insanity 1 I do not pretend to 
deny, that those who have been insane, are exposed to relapses. They nmst 
be more exposed thereto than other patients, because as I have already remark- 
ed, the crises of insanity are often incomplete, and convalescents, for a very con- 
siderable period, are exceedingly susceptible. Physicians who have had charge 
of the insane have doubtless remarked, how many persons who are cured, com- 
mit imprudences, and are not careful to avoid the causes, which first occasion- 
ed their illness. But I am wandering from my subject, and return to the cri- 
ses of mental alienation. 

I think that I have demonstrated by analogy, that mental alienation ter- 
minates by crises. Let us see what observation and experience teach. I 
could relate facts, found in the writings of Hippocrates, Celsus, Coclius Aure- 
lianus, Boerhaave and Pinel, who have pointed out many crises of insanity, 
but I shall confine myself to observations which I have made in my own prac- 
tice, and which will justify my opinion respecting the doctrine of crises. 
Can any one seize upon the order and succession of all the phenomena, 
which appear in the course of an attack of insanity ! Can he point out the 
signs which are to inform us, by what organ the crises are to operate, and de- 
termine the kind of crisis which belongs to this or that variety ! Can he de- 
termine the precise epoch of the crises ! I have been unable to attain this re- 
sult. I have generally observed, that in the course of the first month after the 
invasion of an attack, a very marked remission takes place, after which, the 
delirium returns with greater intensity. At this period, the malady, which 
previously had an acute and violent course, seems to have reached its ter- 
mination ; yet it passes into a chronic state, because the crisis has been in- 
complete. This first remission, which I have studied with the greatest care, 
ought also to be attributed to the cessation of the symptoms, which compli- 
cate insanity at its commencement. If the crisis is complete, the malady 
ceases. Thus, during the fir.st month of the invasion of insanity, a greater 
number of the insane are cured, compared with the whole number of cures 
effected, than during the succeeding ones. 

Mental alienation terminates by resolution. This termination, which is very 
rare in chronic insanity, is announced by a general sense of feebleness, of 



176 CRITICAL TERMINATIONS OF INSANITY. 

lassitude and fatigue ; by paleness of the countenance, and the diminution of 
muscular activity ; by the return of sleep and appetite, or the cessation of vo- 
racity ; by the reestablishment of the secretions, or by their diminution when 
too abundant. All these circumstances, coinciding with the progressive ces- 
sation of the delirium, and with the manifestation of moral sensibility, an- 
nounce an approaching cure. The cure is effected if the patient returns to 
his former views, affections, habits, and character. If we observe farther, we 
are assured that this individual who, during his delirium, could not shed a 
tear, now weeps readily; that another, subject to a cough, expectoration and 
perspiration, and to pains in different regions of the body, has recovered from 
all these slight infirmities which are the safeguards of his good health : for, to 
the observing physician, resolution itself is not merely the normal and suc- 
cessive return of all the functions ; as he always notices some slight critical 
phenomenon. If we add the following signs to those which I have just point- 
ed out, we shall then have the characters of a perfect cure. The patient should 
retain no painful recollection of his malady, and he ought to speak of it with 
indifference ; to meet again, without repugnance, those who have had charge 
of him, and to revisit without reluctance, those places in which he was treated. 
And he should not be unduly fearful with respect to the future, and adopt, 
without pusillanimity, the advice which is given him for the preservation of 
his health. These last characteristics are so essential, that if they are want- 
incr, I always distrust the cure of an insane person. I have seen individuals 
restored to reason, who dared not visit me on their first return to society, but 
who came with pleasure, some months subsequently ; having at that time a dis- 
tinct recollection of their malady, but with it a sense of reestablished health. 
I have seen others, who could not surmount the mortification and shame of 
having been insane, remain melancholic, and soon after, yield to a new attack. 

A young man, twenty-one years of age, of a sanguine temperament, strong 
and robust, spoiled by the kindness and continual flatteries of his relatives, 
of an obstinate and proud disposition, applies himself much to study, in order 
to render himself distinguished among his comrades. He was delirious for 
some days, during the winter of 1805, and suspends his studies for a brief 
period ; returning to them afterwards with renewed ardor. Experiencing 
some slight opposition, he is seized with an attack of mania, near the close of 
the month of December. He requires attentions from every one, complains 
of both his parents, wishes to manage the affairs of the family, and to direct 
them according to his fancy. He is quarrelsome and passionate in his inter- 
course with his father and mother, his friends and associates. His delirium 
extends to every variety of subject, but sentiments of ambition predominate. 

M. B. is committed to our care, Jan. 11th, 1806. In stature he is tall, 
his hair is black, his complexion ruddy, his mobility extreme. He gives him- 
self the airs of a man of consequence, eats much, and drinks in proportion. 
Any resistance to his inordinate desires throws him into fury, and he breaks 
every thing. Thus he passes three months, alternating between calmness, de- 
lirium and fury. If, for a brief period, he seems rational, it is only to grieve, 
and fall into a sort of despair. Tepid and shower baths, acidulated drinks 
and isolation, effect a cure in four months, but my convalescent is sad, gloomy, 
melancholic, and uncontrollably idle. He travels several months, by which 
means his sadness is dissipated, but nothing enables him to triumph over the 
shame of having been insane. Restored to his family, and enjoying the per- 
fect use of his reason, he engages in the exercise of the chase. After six 
months, when his parents feel satisfied and perfectly secure, M. B. is found 
dead in the midst of a forest, by the side of his gun. 

I have noticed convalescents who, for a longer or shorter period, experi- 
enced vexation in consequence of having been sick, and expressed it by com- 
plaints, prejudices, and reproaches without motive. I have seen some who 



CRITICAL TERMINATIONS OF INSANITY. 177 

Still had pains in the head, and cardialgia ; others believed that they still heard 
voices, which addressed them, even internal voices ; while others still, enter- 
tained strange ideas, and acted singularly ; sure signs that the cure was not 
perfect. If with the normal reestablishment of all the functions, with the 
return of appetite, of sleep, of a moderate fullness of habit and regularity of 
the secretions, the delirium does not proportionately diminish, insanity per- 
sists, and becomes, so to speak, constitutional, or passes into dementia. Some- 
times, mental maladies terminate by the predominance of activity in the absor- 
bent system. At the conclusion of almost all maladies, the subjects of them, 
during convalescence, gain flesh to a greater or less extent. This happens 
also, in insanity. There are individuals however, particularly those of a tem- 
perament remarkably lymphatic, whose absorbent system acquires so great 
activity, that they become very fat, attain an inordinate fullness of habit, and 
remarkable obesity. This condition augments progressively for several months, 
and at the same time, the intellectual and moral faculties recover their activity. 
It continues to augment, after the perfect reestablishment of reason, for seve- 
ral months, but finally diminishes to the point to which the patient was accus- 
tomed, previous to his illness. This termination is sufficiently frequent to 
merit notice. 

A lady, twenty-three years of age, of a lymphatic temperament, and of a 
mild and timid disposition, whose father was subject to violent cephalalgia, had 
suffered from several grave aifections, and even delirium, at the epoch of her 
first menstruation. Married at the age of twenty-one years, to one of the 
most distinguished generals, she immediately becomes pregnant. Whilst in 
this state, she leads a sad and monotonous life, has presentiments respecting 
the result of her confinement, and ardently desires the return of her husband, 
who is in the army. Mad'e D. is happily confined. On the seventh day fol- 
lowing, she experiences a severe moral impression ; the lochia are suppressed, 
she is seized with delirium, and becomes furious. Some days afterwards, the 
lochia reappear, and composure returns with reason. On the twenty-fifth day 
after her confinement, she imprudently sits down upon the grass. New dis- 
quietude succeeded. The lochia were suppressed, and she experiences a sort 
of syncope. Delirium and fury reappear with more violence than at first. 
She is bled and bathed. They have recourse to soothing remedies and anti- 
spasmodic drinks, but the delirium increases. They hope that the presence of 
her husband will change this condition. He returns from the army, sees his 
wife, and is prodigal of his attentions ; but in vain. They are both sent into 
the country. The husband soon becomes the object of his wife's fury, and 
his presence occasions violent fits of anger. At length, after three months, 
the patient is committed to my care. Her countenance is pale, skin earthy, 
eyes fixed, breath fetid, and there were convulsive movements of the muscles 
of the face. There is general delirium, continual muttering, resistance to 
whatever may be proposed to her, inappetence, constipation and insomnia. 
Tepid baths, laxative drinks, and exercise in the open air, are prescribed. 
After three weeks the fury ceases, but the delirium persists, and at times, she 
strikes. On the second month, and the fifth of the malady, we apply a large 
blister to the neck, which discharges very abundantly, and laxatives are con- 
tinued for several days in succession. At the sixth month, the sleep, as well 
as the appetite, begins to improve. At the seventh month, the patient eats vo- 
raciously, and sometimes replies correctly to questions that are addressed to her. 
At the eighth month, the vesicatory is suppressed, and she takes an infusion of 
saffron, foot baths, exercise and carriage rides. The menses reappear, and 
the patient begins to gain flesh. Her complexion and skin become more clear, 
and reason progressively returns. At the close of the eighth month, her obe- 
sity is so great, that the young lady becomes solicitous respecting it. I tran- 
quiiize her mind, by assurances that it is altogether factitious, and will be dis- 

23 



178 CRITICAL TERMINATIONS OF INSANITY. 

sipated, in proportion as her health improves. On the ninth month, being 
perfectly convalescent, — after several days' preparation, — I announced to her 
the death of her husband who was killed in the army. She experiences con- 
vulsive movements, which give me uneasiness. I console and tranquilize her, 
I surround her with amusements, and she sees her family. Her convalescence 
is not interrupted. The obesity continued for several months more, and was 
dissipated only at the expiration of two years, although her health was perfect. 
I could cite many similar facts, particularly the example of a young person, 
eighteen years of age, who, in consequence of a panic terror, becomes a mani- 
ac. After six montlis of delirium and fury, the obesity became so considera- 
ble, that I thought it necessary to apply a vesicatory ; the patient already expe- 
riencing constraint in her respiration, and a sort of dementia. 

It happens that, (without our being able to assign the cause of it), some 
individuals become excited, quarrelsome, subject to fits of anger, and won- 
derfully emaciated, many months before an attack of insanity. Almost all the 
insane orow lean during an attack, except those who are threatened with de- 
mentia. We have just seen obesity terminate insanity ; the contrary some- 
times happens. The patient is reduced to the lowest degree of emaciation, 
and insanity is terminated by the most alarming phenomena. The skin be- 
comes brown, black, and cadaverous. Feebleness is extreme. The patients 
have no longer the physical energy necessary for the manifestation of deli- 
rium, still less to be furious. They are almost voiceless. At the moment 
when we believe them ready to succumb ; when they seem to have reached 
the utmost limits of existence, they return from the portals of the tomb, to 
life and reason. Sometimes, this condition is aggravated, by swellings of the 
extremities, gangrenous eschars, and by a relaxed condition of the bowels. 
If there is no organic lesion, if the patient is well nourished, if they strength- 
en him, and ward off too violent moral impressions, the disease terminates in 
health. 

A Jewess, nineteen years of age, of a lymphatic and nervous temperament, 
of a good constitution, but menstruating irregularly, is deceived and abandon- 
ed by her lover. She leaves the house where she is at service, and runs about 
the streets, scarcely knowing where she goes. On returning, she hangs her- 
self. They have only time to lend her the most pressing attentions. She be- 
comes furious, and on the next day is conducted to the Salpetriere. This 
patient is of middle size, with black hair and eyes, a dejected expression, a 
countenance alternately very red or pale, a fetid breath, and livid lips. She 
refuses every kind of food, and becomes furious when they offer her any nour- 
ishment. She desires to remain naked in her cell. The moment any one 
enters her apartment, fear is depicted upon her countenance and her whole 
person. She supplicates them to wait until the next day, persuading herself 
that they are about to seize and conduct her to punishment. She believes 
that a flag-stone that covers a gutter, conceals a frightful precipice, filled with 
all mann.er of filth, serpents and venomous beasts, and that it is into this, that 
they desire to precipitate her. She eats not, because they wdsh to poison her, 
or deduce a reason from what she shall eat, in favor of her condemnation. 
She often makes vain efforts to weep. Sometimes she cries during the night, 
and remains upon the pavement of her cell covered only with her chemise. 
Notwithstanding the rigors of winter, they find her squatting naked, in a cor- 
ner, upon the stone. Throughout the summer, she exposes herself almost na- 
ked, to the heat of the sun. During eight months of delirium and imaginary 
terrors, of crroans and anguish, the patient loses flesh, and her skin becomes 
perfectly brown, like that of a mulatto. This young girl scarce breathes when 
conducted to the infirmary. They administer a tonic potion. On the follow- 
ing day, a serous and abundant diarrhcea comes on. The vital forces give way. 
In vain do they prescribe remedies to moderate it ; the patient is unwilling to 



CRITICAL TERMINATIONS OF INSANITY. 179 

take any thing. The diarrhoea ceases only at the expiration of a month, when 
N. is thought to be near her end. They cause her by force, to swallow a few 
drops of wine and broth. Some days subsequently, a more abundant nour- 
ishment is taken with less repugnance. By degrees, the forces rally, reason 
returns progressively, and disquietude only remains. On the eleventh month 
of the malady, the menses return, and on the succeeding one, are abundant. 
The epidermis falls off in scales, and the skin recovers the hue of health. 
Reason is established, and our convalescent is employed in the service of the 
house, in order to assure us of the restoration of her health. 

There are few chronic maladies, that have not been cured by the develop- 
ment of an unexpected fever. All practitioners cease not to express regret at 
not having it in their power to induce it. Many have endeavored to accom- 
plish this purpose. The physician having charge of the hospital for the in- 
sensates at Tubingen in Wurtemburg, causes the insane under his control to 
take calomel in repeated doses, in order to kindle up a febrile movement. In 
this, he sometimes succeeds. Cold baths and affusions, produce the same 
result. What art cannot always accomplish, nature performs for some indi- 
viduals, and it is not unusual for symptomatic and essential fevers to termi- 
nate insanity. I saw it once brought to a close, by an inflammatory fever. 

A young man, a native of Caen, twenty-three years of age, of a lymphatic 
temperament, nervous constitution, and a lively, sensitive disposition, had been 
much troubled with hemorrhoids. After the early storms of the revolution 
had passed away, he devoted himself with great assiduity to commerce. At 
the age of twenty-one years, he conceived a most violent passion for a young 
person, who did not regard him with indifference. One of his friends reveal- 
ed to him a purpose which he entertained, of marrying this lady. From that 
moment M. B. conceals his attachment, and continues to live with his friend 
and her whom he loves, without betraying, his sentiments. He gradually how- 
ever, became sad, gloomy and retired. Meanwhile, his mother dies, and he 
experiences in consequence of it, the profoundest grief He conceives a dis- 
like to his occupations, forms the resolution of abandoning commercial pur- 
suits, of quitting his family and the place where he was born. He rejects 
those pleasures which are especially interesting to those of his age, and only 
enters society when propriety requires. He passes the following winter, in 
this state of melancholy, suffering at one time from constipation, at another, 
from relaxation of the bowels, and complains of frightful pains in the head. 
On one of the earliest days of spring, he is unduly heated, and becomes ex- 
cited in a numerous and noisy assembly. In the middle of the evening, whilst 
dancing with his beloved friend, he is seized with convulsive movements. 
The most violent delirium bursts forth, the patient betrays his secret, reveals 
his love, and reproaches himself, calling incessantly upon the object of his 
passion. He forgets his relatives and friends, and refuses all assistance. 
This condition persists for four days, and several men are scarcely sufficient 
to confine him in bed. The convulsions cease, but the delirium increases. 
The patient refuses the remedies that are presented to him, and pretends that 
he alone can cure himself One of his friends however, induces him to sub- 
mit to be bled in the foot, and to take some cooling and sedative drinks. Less 
agitation succeeds, but the incoherence of ideas and actions is the same. He 
experiences an irresistible desire to walk about, and has recourse to a strata- 
gem, to relieve himself of the watchfulness of his relatives and friends. He 
threatens and strikes even, those who oppose his wishes, or who accompany him 
in his walks. Such are the features which characterize this malady, during 
the first two months, after which the patient is committed to my care, about 
the middle of the month of April following. On his arrival, he descends 
from the carriage without noticing any one, ascends the stairs, and descends, 
and ascends again, with extreme promptitude. On seeing me, he touches my 



180 CRITICAL TERMINATIONS OF INSANITY. 

hand : " You are Bonaparte, I know you, I have seen you ; how much plea- 
sure it gives me ! are you not him 1 embrace me ; I am your secretary." I 
endeavor to remove this illusion ; the patient insists, and becomes threatening : 
" You have done well, ^ays he, and I am not mistaken." He runs about, 
goes out and returns, unable to remain an instant in a place. 

A friend who accompanies him, assures him that he is at the house of a 
physician, — " Bah ! bah ! you toill not deceive me." We sit down at the ta- 
ble, and he devours the provisions set before us. Joy is depicted upon his 
countenance, his face is flushed, his eyes gleam, and his movements are hasty 
and abrupt, as well as his speech. He retires, and rises during the night. At 
break of day, he is with me. He lays hold of all the bocks that come in his 
way, puts them in place, takes them down again, returns them, or turns them 
over and over. He wishes to write, takes up the pen, and lays it down again. 
He rises up and sits down, goes out and returns to me, and prays me to write 
a letter to his beloved friend. I decline ; he traces himself certain insignfi- 
cant words, gives me the paper to subscribe, and wishes me to sign a fictitious 
name, I bring to his recollection the danger there would be in my signing a 
false one. Fear nothing he says, I am answerable for the vt'hole. I still re- 
fuse, and he insists. Finally he seems to yield, but immediately pretends that 
I am a female in disguise. He goes out hastily, and runs about the court and 
gardens. He leaps over all obstacles, even a barrier eight feet high. He be- 
lieves himself possessed of supernatural power, which enables him to sur- 
mount all dangers. I place near my patient, a strong and robust attendant, 
who follows him wherever he goes, without opposing his movements in any 
respect. His presence resulted in imposing some restraint upon the patient, 
whilst I exert myself to gain his confidence. After the second day, M. B. 
wishes to make to me a certain revelation, but the ideas which are to express 
it, fiiil him. He collects all the little stones in the gardens, which he regards 
as gold or diamonds, and of which he makes a collection in his chamber. 
Upon paper, the walls, gates, the enclosure, and the sand, he v/rites lines, 
which he calls verses. He traces insignificant phrases, and always the name 
of his beloved. His countenance is uniformly very red, his eyes shining and 
very changeful, his pulse full, hard and frequent; constipation and insomnia 
obstinate. His appetite is voracious, his loquacity continual, and his mobility 
incoercible. Nevertheless, w^e sometimes find him sad and thoughtful ; his 
eyes bedewed with tears, without his being able or willing, to assign the cause 
of his emotion. 

During the first eight days, nauseating drinks are prescribed. From the 
eighth to the twentieth of May, his muscular activity is very great, and he 
seems to feel a sort of necessity to destroy whatever comes w'ithin his reach : 
the locks, bed, curtains, and linen, a flute and pipe, all are torn or broken. 
He believes that he recognizes every one whom he meets, and endeavors to 
console them, thinking them very unfortunate. He lays hold of whatever he 
finds. At one moment he runs with extreme swiftness ; then suddenly stops, 
panting and perspiring with fatigue. For a brief period, he appears to be in 
a revery, but sets off again at a rapid pace, so soon as any one approaches 
him. While in this state, if I desire to restrain him by laying hold of his 
arms, so long as I hold him, the muscles of his face are convulsed, and he 
beats the ground, not with anger, but from impatience, and is constantly mov- 
ing his limbs and head, not in a menacing manner, but from his internal de- 
sire to run. If during his intervals of repose, I question him, he makes no 
reply. If I offer him advice, he does not appear to comprehend me. His 
whole being seems to be agitated with an irresistible necessity for motion. I 
yield to this impulse, and already the patient is far from me. 

May 20th. About this time, M. B. becomes more disposed to ask ques- 
tions, and converses more. His movements are less active, his eyes less lively, 
his countenance less flushed. He sheds tears, and sometimes seems to realize 



CRITICAL TERMINATIONS OF INSANITY. 181 

his condition, and testifies much confidence. He Avishes to write to his rela- 
tives, but his letter is destitute of meaning. After a remission of three days, 
the patient has a new paroxysm, which continues for three weeks. 

June 10th. Shivering, cephalalgia, and flashes of heat occur ; his counte- 
nance is sullen, his eyes gleam, and his pulse is hard, full and strong. He 
suffers from nausea, and his tongue is covered with a yellowish coat. The 
patient feels the need of confining himself to bed, and converses rationally. 

June 11th. An emetic causes him to vomit abundantly, and also produces 
several alvine evacuations. In the evening he perspires. June r2th. The 
gastric symptoms disappear, but there is cephalalgia, attended with a hard and 
full pulse, flashes of heat, and a feeling of general lassitude, with thirst. 

June 13th. He is bled from the arm, and during the night followinor, the 
secretions of perspiration and urine are abundant, as well as on the three suc- 
ceeding days. June 18th. Apyrexia — countenance pale. The patient ima- 
gines that he has just awoke from a long dream. There is no lesion of the 
understanding, but great feebleness of memory. June 26th. Convalescence, 
and a return of the vital forces. Although the patient seemed to have lost 
his memory during the delirium, he preserves, at his convalescence, a recollec- 
tion of the least important circumstances connected with his malady, testifies 
the most entire confidence in me, and desires to resume his former occupa- 
tions. He sees his friends again. I multiply around him, so far as possible, 
the means of diversion. Tepid baths are prescribed on alternate days. 

July 7th. Indications of gastric embarrassment. Nauseating drinks are 
prescribed for three days. Reason perfect. Alvine dejections abundant. 

July 21st. This young man returns to society perfectly cured, not only of 
his delirium, but of his love. One year after, he is present at the marriage 
of her who had been the object of his passion, and the cause of his disease. 
Four years subsequently, he marries himself Since that period, he has be- 
come the head of an immense establishment, which he manages most suc- 
cessfully. 

I have seen insanity terminate by gastric fever. A military officer, (his 
brother died insane at the age of twenty years), forty-one years of age, com- 
manded a frontier post, and after having supported all the fatigues of the war, 
and escaped the consequences of a rupture of the crural artery, becomes in- 
sane, through despair at not having received the cross of the Legion of Ho- 
nor. After the victory of Austerlitz, he prepares a discourse in praise of the 
victor, commands the garrison to take arms, and orders them to kneel, while 
listening to this discourse This conduct of commandant C, gave rise to re- 
marks, which came to his ears. On the followmg day he is delirious, and has 
attacks of fury. His brother comes, and removes him to his family, where they 
both bleed and bathe him. M. C. is gloomy, and regardless of his wife and 
children, desiring to fly from both them and his country. After some months, 
he escapes, and proceeds to Paris, to another brother, who receives him with 
tenderness. After some days, new signs of insanity appear ; even jealousy, dis- 
trust and excitement ; and the patient is committed to my care April 1st, 
1806. His eyes gleam, and are very changeable. His countenance is also 
very much flushed and convulsive. The patient prostrates himself upon the 
earth, and adores the sun, which he regards as the father of nature. Does 
he walk in the gardens, he thinks himself in the Champs-Elysees, He looks 
upon a patient and the gardener as Nereids, as they are occupied in drawing 
water, another is taken for Rhadamanthus, himself for Minos, etc. At the 
end of fifteen days, having become more calm, M. C. no longer prostrates 
himself, converses more willingly, but still believes himself to be the great 
priest of the sun, son of Zoroaster ; now defying Christ, and now consider- 
ing himself to be Jesus Christ, destined to reform the world, and to improve 
the moral condition of men. At times, he utters frightful cries, in conse- 



182 CRITICAL TERMINATIONS OF INSANITY. 

quence of agonizing pains; imagining that a fiery serpent has escaped from 
the sun, and entered his stomach. We apply leeches to the anus, administer 
baths, douches, and acidulated laxative drinks. Near the close of the month 
of August, the patient is seized with gastric fever. After five days, it takes 
the character of a tertian intermittent. I prescribe no remedy, and leave the 
case to the efforts of nature. After the seventh attack, this soldier had en- 
tirely recovered his health. 

M. L., a student in surgery, of a slender constitution, and a gloomy, melan- 
choly disposition, had experienced some domestic troubles before coming to 
Paris, where he devoted himself with the greatest ardor to the study of ana- 
tomy ; sustaining himself upon slightly nutritious food. From spring-time he 
sleeps less, becomes querulous among his comrades, and imagines that they 
make sport of him. Near the close of the month of June, while present at a 
lecture of professor Boyer, he utters a loud cry ; saying, " I am lost, I am 
damned, I must die." They bleed him in the foot, and in the jugular vein, 
and administer sedative and cooling drinks. Every attention is lavished upon 
him. The patient repulses those about him with violence, utters cries, calls 
them by opprobrious epithets, spits in their faces, is unwilling to drink, and 
becomes much emaciated in a few days. July 28th. The patient is com- 
mitted to my care. His countenance is alternately pale and red, his features 
wan, his eyes shining and fixed ; his breath fetid, and his pulse extremely fre- 
quent. The delirium is general, with a predominance of religious terrors. 
He breaks, mars and rends every thing, and endeavors to injure himself If 
we offer him any remedy or nourishment, he becomes furious. Several atten- 
dants find it difficult to restrain him. His fury is sometimes spontaneous, his 
thirst urgent, and his dejections involuntary. July 31st. A new and instan- 
taneous paroxysm of fury, followed by a comatose state, which we believe 
feigned. Towards evening his face becomes very much flushed, skin hot, 
pupils dilated, and his right arm very painful, when he attempts to extend it. 
Pulse frequent, delirium continued. At evening, the urine is tinged with 
blood. Acidulated and nitrous drinks are prescribed, the tepid bath, cold 
water to the head, etc. Aug. 1st. The right arm is covered with an erysipe- 
latous eruption, the urine sanguinolent, and the pulse very frequent. '2d. 
Same as at evening. 5th. Symptoms all exasperated, pulse very frequent, and 
subsultus tendinum. A drachm of camphor and nitre are taken during the 
twenty-four hours ; wine whey, and vesicatories to the limbs. 6th. Frequency 
of the pulse diminishes, perspiration abundant. 7th. Apyrexia, continuation 
of delirium. 8th. Paroxysm of fury, apyrexia. 9th. Delirium and fury. 
10th. Slight paroxysm, delirium, general sense of feebleness, paleness of the 
countenance. 12th. The patient rises ; incoherence. Camphorated Peruvian 
bark. 16th. Eruptions over the whole body. 18th. The pimples grow white ; 
at times delirium. Vinous water, as a drink. 2'2d. Progressive return of 
the vital forces, and the patient, rather restless than delirious. 28th. Conva- 
lescent. He is now put upon the use of analeptics, milk, and exercise. He 
sees his parents with composure, and at length, after some days of painful re- 
veries, returns to the bosom of his family, where, after a long and trying con- 
valescence his health is perfectly restored. It is many months before he is 
able to resume his studies, his brain remaining very feeble. After an interval 
of a year, he returns to Paris, and resumes his medical studies with the great- 
est success. 

We had at the Salpetriere, a woman who had an attack of mania, on three 
successive years, and which terminated by an ataxic adynamic fever. I pre- 
vented the fourth attack, which she would otherwise have had on the following 
year, and this year (1815), she has not even had the premonitory symptoms.* 

** (jalen reports the cure of one case of mania, by a quartan fever. 



CRITICAL TERMINATIONS OF INSANITY. 183 

Hemorrhages, whose suppression often causes insanity, sometimes terminate 
it. A young man, nineteen years of age, while attending the school at Fon- 
tainebleau, is seized with an attack of mania, which renders the most energetic 
treatment necessary. He is bled largely. After fifteen days, his agitation 
ceases, and the patient becomes, as it were, stupid ; wallowing upon the 
ground, devouring substances the most filthy, speaking not, and disposed to 
strike on the slightest opposition ; yielding sometimes to spontaneous acts of 
fury. His face is flushed, his eyes rendered dim by a discharge, and his nose 
and mouth are constantly full of a mucous matter, which runs out upon his 
garments. The patient often attempts to beat his own head. After many 
months of useless attentions, I resolve to employ sternutatories. He bled at 
the nose at times for several days, and reason began to return. Convalescence 
soon followed. 

During the war of Vendee, M. G., the father of a family, about thirty-eight 
years of age, large and strong, being in the habit of losing blood every year 
to remove a sore throat which made him apprehensive of suffocation, neglected 
this precaution. In the summer of 1800, he is often obliged during the night, 
to sit up in bed, feeling as if he were about to suffocate. At the approach of 
winter, these symptoms disappear, but the patient becomes uneasy, jealous, 
timid and gloomy, with respect to certain matters of importance. At the be- 
ginning of April 1801, it is observed that he is absent minded, and indifferent 
about his family and business. He goes out and comes in without a motive, 
censures himself for his faults before every one he sees, and asks pardon for 
them. On the day following a sleepless night, he suffers from agitation and 
delirium. An emetic is given him. Twelve leeches applied to the feet, re- 
lieve him. He is confined to his bed, and some days subsequently, leeches are 
applied to the anus, and a tepid bath given. Health is restored. Two months 
pass ; but towards the end of June, a new paroxysm occurs, accompanied by 
a chill and fever, and a refusal to employ any remedy. Six men with difli- 
culty confine the patient to a cold bath ; on leaving which, he is more rational. 
The same baths are employed on the following days, with equal success. 
This paroxysm lasts eight days, and since that period, is renewed almost every 
month. We have successively bled, purged and bathed the patient. To- 
wards the end of autumn, the paroxysms are irregular. The patient talks 
irrationally, and is at times, turbulent and passionate. He is, ordinarily, ra- 
ther gay than sad. In his lucid intervals, there remains an air of assurance, 
an imperious tone, and a kind of laugh, foreign to his natural habit. 

After a year's treatment, the patient was sent to Paris, and committed to my 
care, Feb. 25th, 180!2. M. G. has light hair, bright eyes, a countenance 
very much flushed, and the external appearance of a strong man, in the enjoy- 
ment of excellent health. He is troubled about nothing. He goes and 
comes, playing tricks upon every body, laughing till his sides ache, at the 
merest trifle, and sometimes at nothing. No idea, no recollection, could fix 
his attention for a moment. Content with himself, he is the friend of all, and 
has not a thought for his family. Suddenly, his face becomes more flushed, 
his eyes are red and glistening, and there is heat in the abdomen. Afterwards, 
the most general delirium seizes the patient. He threatens and strikes. A 
great array of force does not impress him. This state persists for seven or 
eight days, and terminates by a general sense of fatigue, with a desire to sleep. 
It is renewed several times. The intervals between one paroxysm and another, 
do not leave the patient exempt from the full force of the delirium. He is 
proud and haughty. He insults every one, and is constantly laughing convul- 
sively. During the paroxysm, the patient experiences heat in the head, and a 
burning sensation in the stomach and intestines. Acidulous and nitrous drinks 
are exhibited, tepid baths, douches, lotions of oxycrate to the head, leeches to the 
anus, pediluvia, acidulated drinks and laxatives. During the first two months. 



184 CRITICAL TERMINATIONS OF INSANITY. 

composure and excitement alternate. Cold baths and douches are demanded 
by the patient. 

August. Peruvian bark during the remission ; leeches to the anus daily, 
for fifteen days ; tepid baths, with cold water to the head, exercise, and diver- 
sion by the culture of the garden. A hemorrhoidal flux comes on, which is 
so copious for several days, that I become alarmed. The patient is pale, 
thoughtful, gloomy and timid ; desiring to return to his family, and reason- 
ing very properly. September. A return of the hemorrhoids, and a continu- 
ance of health. Towards the end of the month, the patient still laughs at 
times, without cause. On the following month, the hemorrhoids again appear. 
Composure and correctness of thought, are more marked. Tired of a life of 
inactivity, our patient returns home on the twenty-first of October. In the 
spring following, his relatives and friends fear a relapse. I advise the applica- 
tion of leeches to the anus, foot baths, lotions of vinegar to the head, acidulat- 
ed drinks, and aloetic purgatives. The hemorrhoids discharge, and all unea- 
siness is dissipated. Five years subsequently, he sees one of his children sus- 
pended from the casement of the garret window, ready to fall, and many peo- 
ple hastening thither. Almost motionless from fright, he runs and saves his 
son. To this violent emotion, succeed all the signs of a new attack. They 
make repeated applications of leeches, and administer baths, with cold water 
to the head, together with cool and laxative drinks. In this instance again, 
the symptoms only appear.* 

. I never knew, from my personal observation, insanity to be terminated by 
the rupture of varices, but was acquainted with one person who was insane, 
and who, at this time, is advanced in life, and has varicose limbs. t Suppres- 
sion of the menses is a frequent cause of insanity, whether it may have been 
produced by a strong moral affection, or some error of regimen. Insanity, 
depending upon this cause, terminates by the reestablishment of the menstrual 
flux. However, when hereditary disposition, or a vice of conformation pre- 
disposes to insanity, which occurs from an accidental cause, at the commence- 
ment of the malady, the menses are suppressed. But though promptly re- 
stored, they do not relieve the patient from the malady. When the menses 
flow freely without a return to health, we may then fear, lest the patient be- 
come incurable ; but so long as they are not established, it is proper to enter- 
tain some hope of cure, especially in early life. 

Mad'e C, twenty-nine years of age, and the mother of two children, having 
had distant connections affected with mental alienation, was of an extremely 
jealous disposition. Scarcely is she married, than her jealousy is called forth 
with respect to her husband, who however, furnishes no occasion for the exer- 
cise of it. Without any assignable cause, she experiences a violent attack of 
jealousy, followed by the suppression of the menses, and a maniacal delirium. 
After some months of fruitless treatment at home, she is committed to my 
care. Her hair and eyebrows are black, her brow wrinkled, her eye bright 
and concealed beneath the eyebrows, her look asquint, tongue white, and the 
body loaded with flesh. The patient believes that she hears her husband, and 
supposes that he is near her, but concealed and retained by his mistres.ses. 
The women who surround and serve her, excite her jealousy. She hears them 
speaking in abusive terms, in a low and cowardly tone. Now, she remains 
whole hours without moving ; now springs with the speed of an arrow, takes 
a hundred steps and stops. She has heard her husband, who is absent. At 
other times, her step is slow and tortuous.. She makes the day to consist of 
forty-eight hours ; breakfasts and dines on the first, but does not retire to bed. 
On the following day, she takes luncheon and sups ; and the day being finish- 

* ZacHtus-Lusitanus relates a similar case. 

t Decaballis, Phenomena Medici, says that mania terminates by the rupture of vari- 
ces. Hipp., aph. 21, sect. 6. Boerhallve, aph. 124. 



CRITICAL TERMINATIONS OF INSANITY. 185 

ed, she retires. It was several months before she could decide to retire vo- 
luntarily on the intermediate day, or change her mode of measurino- time. 
She persuades herself, that those about her are constantly occupied in acts 
disobliging to her, which provokes, on her part, outbreaks of fury. The ab- 
domen is voluminous, hard, and often affected with colic pains. Constipation 
is obstinate, and persists from fifteen to eighteen days. In vain do they de- 
sire to administer an enemata, and apply leeches. She believes that they wish 
to violate her person, because, says she, men must have several women. Six 
months pass in this state, and she makes less resistance to the use of the bath. 
At length, they oblige her to take hip-baths daily, and to drink a laxative 
ptisan. The patient appears a little more calm, although her face is very 
much flushed. She complains of colic pains, and is more ready to do what is 
prescribed for her. However, her notions and infatuations are the same. 
She does not recognize the hand-writing of her husband, and is unwilling to 
hear her children spoken of, though her condition may be somewhat improved. 
I resolve to send her abroad in a carriage on the three days of the carnival. 
She enters it on compulsion, and rides for four or five hours each day. On 
returning at evening, she appears less gloomy and dissatisfied. On Monday, 
the menses make their appearance, and flow abundantly on Tuesday. From 
this period all her views are correct, all her prejudices are dissipated, her hal- 
lucinations cease, the excretions are reestablished, and at the end of a month, 
she is in a condition to return to her family. 

Mad'lle E., thirty years of age, of a nervous temperament and delicate 
constitution, a vigorous imagination, a mild and sensitive disposition, is aban- 
doned by her lover, by whom she had become a mother. She becomes sad, 
and grows lean rapidly. The menstrual flow is imperfect, irregular and scan- 
ty. She suffers from constipation and colic pains. Some months after this 
period, the fruit of her labor and economy is stolen from her. The menses 
are suppressed, and her child dies. Her grief is at its height. The menses 
do not appear, and at the expiration of ten days, the most violent fury bursts 
forth. The patient is delirious on all subjects, and is brought to the Salpe- 
triere Oct. i;3th, 1801. She has black hair, a dark complexion, haggard 
eyes, a countenance very much flushed, though sometimes pale, a fetid breath, 
and livid lips. She suffers from extreme agitation, utters cries, indulges fear, 
employs menacing language, and at intervals, breaks out into convulsive laugh- 
ter. She swears, strikes, and does not recognize her relatives and friends. 
Notwithstanding the disorder of her ideas, she is disconcerted on finding her- 
self in a hospital, and is more composed. At night her agitation returns. 
Constipation obstinate. Fifteenth and sixteenth. Tepid baths with cold wa- 
ter to the head. There is composure, occasional colic pains, transient chills, 
and momentary paleness of the face. Eighteenth. The patient listens to 
suggestions and advice ; testifies some degree of confidence, and is less deli- 
rious. The alvine dejections are effected with pain, and the sleep is light. 
The menses appear. Nineteenth. A very marked remission. She walks 
with naked feet, which is followed by a suspension of the menses, flushing of 
the face, and gleaming of the eyes. There is general uneasiness and disquie- 
tude, distrust and transient delirium. Foot-baths and aromatic drinks. Sleep 
follows, and a return of the menses, which flow abundantly. On the follow- 
ing days the patient experiences every evening a slight febrile heat, succeeded 
by a copious perspiration. On the following month, the menses appear with- 
out effort or excitement, and she is restored to her family, some days after the 
menstrual period, yet experiencing violent attacks of hysteria. 

Affections of the skin merit special attention in the study of insanity. The 
repercussion of herpes has often caused this malady. Sometimes insanity 
appears so dependent upon the development of a psoric affection, that it ap- 
pears at the same time that the herpetic eruption becomes manifest. 

24 



186 CRITICAL TERMINATIONS OF INSANITY. 

A young man, seventeen years of age, being at the lyceum in the province, 
is suddenly seized with an attack of mania. He is committed to my charge. 
I prescribe tepid baths and a cooling drink. There is manifest upon his 
countenance, a herpetic eruption, which gradually becomes extinct, and at the 
same time that the delirium disappears. A month after, his father brings him 
to Paris to pass the carnival there. He becomes greatly fatigued. On Shrove 
Tuesday he got tipsy, and his father brought him back again to me, worse 
than at his first attack. Herpes covered his whole cheek, but after the use of 
tepid baths, of bitter and sudorific ptisans, together with much exercise, it 
disappeared along with the delirium. During the following autumn, after a 
frantic revel, delirium returns, in connection with the herpetic eruption. For 
two years, it appeared in spring and autumn. For the last four years, this 
young man, having submitted to healthful regimen, and led a very active life, 
has enjoyed excellent health, and for two years engaged in the war. 

A young Englishwoman, while residing at Rouen, becomes furious, and is 
brouo-ht to me, covered with a herpetic eruption. She is cured after four 
months, of the attack. I apply a vesicatory, and advise a mild regimen and 
baths. Every thing is neglected. In the spring of the following year, she 
has a new attack. The body is covered with herpes. After the cure of this 
second attack, I apply a vesicatory, and the use of the baths is continued. 
The blister is replaced by a cautery. Since the epoch of the return of the 
malady is passed, certain red spots appear upon the person, unattended by 
cerebral symptoms ; but violent colics, hysterical syncopes and vertigoes, coin- 
cide with a greater eruption upon the surface, yet without delirium. Baths, 
depuratory drinks, and an active life, dissipate all these symptoms. This 
young woman enjoys perfect health for five years, and has returned to her 
native country, where she has met with many causes of chagrin, and changed 
her regimen and mode of life, without being sick. 

If herpes causes insanity, if it sometimes proceeds in company with it, 
without doubt it sometimes terminates it. I have observed this termination. 

A young man twenty years of age, very strong and robust, had, at the age 
of seventeen years, an herpetic eruption which occupied the whole of the right 
side of the chest. By the use of appropriate remedies, he was cured, and gave 
himself up to study, and particularly to pleasures. The disquietudes connect- 
ed with the conscription, caused him to lose his reason. He is much agitat- 
ed, and commits a thousand extravagances. At the expiration of a month, he 
is committed to my charge. I leave the patient to his fancies. He bathes 
and takes a laxative ptisan. A month has scarcely elapsed, when a herpetic 
eruption appears upon the left foot. His ideas immediately become more just, 
his conversation is connected, and a few days subsequently, this young man 
enjoys the fnll measure of his reason, and in less than six weeks is restored 
to his family. 

It is the consequence of psora as well as of herpes. During the last cam- 
paign in Prussia, they brought into the military hospital a horseman, present- 
ing all the symptoms of an ataxic fever. After some days' observation. Doc- 
tor Roux, — now principal physician to the army, believed that he recognized 
a veritable mania. He prescribes tepid baths. From the time at which the 
first bath was given, he notices the eruption of psora. The baths are contin- 
ued. This eruption extends over the whole body, and the delirium lessens in 
proportion as the psora progresses. After fifteen days the patient is restored 
to reason, but the body is covered by this cutaneous affection. The mildest 
measures are employed. It is removed, and at the close of the second month, 
this soldier resumes his duties. 

M. de S., twenty-seven years of age, of a nervous temperament, descended 
from a father whose imagination was singularly disordered, having had also an 
uncle and sister insane, and possessing a very strange and inconstant disposi- 



CRITICAL TERMINATIONS OF INSANITY. 187 

tion, had been attacked with psora while in the army. This affection was 
treated, and disappeared in a few days. Four years afterwards, having left 
the service, he abandoned himself to the grossest irregularities, committing 
every variety of excess in regimen. He experiences some opposition, becomes 
sad, complains of constipation and pains in the head, and loses much flesh. 
After two months, he suddenly becomes furious, and knows not the voices of 
his relatives and friends, whom he strikes indifferently. He believes that 
every one deceives him, that he is going to be given up to justice, and that 
his mistress will be sacrificed. He converses little, refuses nourishment, or 
eats voraciously. After some days, he is committed to my care, Jan. 24th, 
1808. He has light hair, eyes blue and fixed, face pale, breath fetid. There 
was a general trembling of the body, attended with an expression of fear, so 
soon as any one approached him. His lips were in continual motion, and he 
obstinately refused either to speak or move. At other times, the patient moves 
about and converses much. Several times, he endeavors to dash his head 
against the walls. At these seasons his face is extremely red, and his eyes 
gleam. There are moments when he gives himself up to the commission of 
the blindest acts of fury, employing whatever comes to hand, to assail any in- 
dividual who may approach him. This patient has since infomed me, that 
he distinctly heard a voice, which counselled him neither to speak, walk or 
eat ; and which assured him, that he must slay some one, in order to be saved 
and free. This voice kept him awake, threatening him with dangers the most 
terrible. Application of leeches, acidulated drinks, and tepid baths. 

May. Nauseating drinks for many days together ; provoking abundant de- 
jections, and a slight eruption upon the skin. June. Bitter drinks, tepid 
baths, and the application of leeches to the temples. The patient converses 
more willingly, sleeps a little, and trembles less. There is a manifest remission. 
July. Leeches applied anew to the head, cold baths, douches. A marked 
amelioration. August. An aloetic purgative, tepid baths, and a blister to the 
neck. A more marked advance towards reason succeeds. Pimples are more 
numerous upon the body. September. Convalescence perfect. The patient 
is restored to his family during the month of October ; his dejection, irreso- 
lution and sadness continuing, or giving place to a disordered gayety. Nov. 
He gives himself up anew to some errors of regimen, and resumes his former 
disposition ; at the same time informing me that his cutaneous disorder has 
returned. In fact, I examine him, and find his body, particularly the arms, 
covered with pimples, attended with an insupportable itching. I was unable 
to induce him to take care of this new affection, which tormented him for 
more than a year. There has been no cutaneous affection for four years, nor 
has his reason been affected. 

M. de X., a general and inspector of reviews, thirty-eight years of age, of 
a sanguine temperament, tall, with black hair, a lively and glowing imagina- 
tion, gave himself up to excessive masturbation, although very devoted to 
study, and leading a very active life. He experienced, two years since, ex- 
cessive mortifications, which rendered him sad. He is sent to Italy, takes the 
itch, and treats himself In eight days, the eruption disappeared. He now 
experiences some opposition, called forth by the uprightness of his conduct, 
and the severity of his inspection. His disposition is soured, and he becomes 
irritable and passionate. They impeach him, and he goes to Paris to justify 
himself Certain indications of delirium are noticed in his conversation. 
One of his friends is so imprudent as to say to him, that he had been im- 
peached because he was insane. He then becomes so in reality; is furious, 
and threatens the lives of all those who surround him, even that of his wife. 
They bleed him several times, bathe him with cold water, and administer the 
bath of surprise. He sinks into dementia, complicated with general paralysis. 
Suffering from involuntary dejections, momentary attacks of fury, fright, when- 



188 CRITICAL TERMINATIONS OF INSANITY. 

ever any one approaches him, voracity, insomnia, and constant cries, he is 
committed to my care in the spring of 1805, Baths, whey, aloetics, and Pe- 
ruvian bark are successively administered, and the severest watchfulness is 
exercised to prevent masturbation. Exercise, both by walking in the open air, 
and by riding, is taken ; yet nothing changes the condition of the patient. 
But though extremely fearful, he becomes affectionate, extending his hand, 
and smiling, to all those who approach him. Hoping that if I could again 
communicate to him the itch, I should cure him, I employed tepid baths, and 
friction morning and evening. He takes tonics internally, and sleeps in the 
shirts of those affected with this disorder for fifteen nights. Professor Alibert 
provides me with the virus of psora. I make about the articulations of the 
limbs, more than eighty punctures, with no better success. I cause the pa- 
tient to sleep anew in infected shirts, with no better success.* 

[The immediate cause of psora being now well understood, the want of success in in- 
oculating with the matter of the vesicle is not surprising. Not only is tliere nothing 
specific in this matter, but the insect (jlcariis TScahei), by whose irritation it is produced, 
is not found in the vesicle itself, but distant from it usually two lines in extent.] 

Chilblains have also some influence upon the progress of insanity. 

I had charge of a young man eighteen years of age, who, from the age of 
thirteen years, had been in a state of mania, which alternated with dementia. 
The delirium lessened, and reason resumed its seat for many months, while 
he was tormented with chilblains on his heels and the fingers of his hands. 
The sores discharged abundantly. Several issues were established, after the 
suppression of the chilblains. This young man continues in a state of de- 
mentia, accompanied by fury, which has assumed an erotic character since 
the age of puberty. 

Furuncles often make their appearance among<the insane, and become cri- 
tical in some cases, especially when the suppuration is very abundant. I have 
observed this critical termination, particularly in the case of two individuals, 
both of whom were exceedingly fleshy, and had what is called a humoral con- 
stitution. 

M. de T., an old soldier forty-seven years of age, descended from a father 
and uncle who were insane, of a sanguine temperament, subject for a long 
series of years to a trembling of the hands, was of a mild disposition, indiffe- 
rent, irresolute, of limited mental capacity, and poorly adapted for study. Al- 
though destitute of passion, he was very fond of women, and by no means 
difficult in his choice. His education was neglected, and his fortune impaired, 
both by the injustice of his relatives, and the consequences of the revolution. 
His wife having had eleven abortions, he was greatly afflicted, in consequence 
of not having children to whom he could leave his name and fortune. For 
some time past, the trembling of the hands having diminished, the patient has 
been troubled with hemorrhoids, and has become gloomy. During the year 
1801, he became sad, taciturn, indifferent about his affairs, his wife and 
friends ; indulging also in many liberties with the ladies. Eating much, and 
taking little exercise, he becomes corpulent. Spring of 1802. Impairment 
of the intellectual faculties, especially of the memory. The patient leaves 
his house without a purpose, and returns thither without a motive, and at all 
hours. Twice, on the same day, he goes on foot to the residences of a lady 
and a cousin, to demand their hand. At another time he wishes to drown 
himself Finally, he sometimes leaves his hotel, and not returning, is found 

* Gardane assures us, that mania can be cured by inoculation. Fischer and Riedlin 
make the same observation. Decostes mentions a case of mania, which was cured by 
the itch. 



CRITICAL TERMINATIONS OF INSANITY. 189 

on foot, many leagues distant, upon the public road, not knowing whither he 
is going. May 1st, 1802. The patient is brought to Paris, and committed 
to the care of Pinel and myself His face is pale, features relaxed, his eyes 
fixed, his hands tremble. He totters upon his legs, has a voracious appetite, 
thirst, and difficulty and pain in urinating. His memory is enfeebled, and 
intermediate ideas are wanting, to carry on a process of reasoning. Some- 
times, he becomes violent, and his delirium then takes the form of excitement. 
His face is flushed, his eyes glisten, and his movements are free and constant. 
He cries, breaks, rends, displaces and gathers together every thing that he 
meets with. Leeches are applied to the anus, which occasion an abundant dis- 
charge, and laxative drinks produce dry and black dejections. His sleep is 
troubled by frightful dreams. 

June. Baths at 22'^ (Reaumur) ; douches, with no effect. Blister to the 
neck, followed by a remission. Some days afterwards, he has a rigor, with a 
tendency to stupor. There is a return of delirium, attended with agitation, 
fury, and a desire to destroy. Leeches are applied to the anus. 19th. A he- 
morrhoidal flux, followed by still greater exasperation of the symptoms. He 
indulges in obscene proposals, and makes up a matrimonial project. He has 
an irresistible desire to walk about, and employ his hands in doing mischief. 
Baths, with lotions of cold water to the head. 29th. Suddenly, amidst fright- 
ful cries and howls, he calls upon his son, (though he has no child), and per- 
sists in remaining naked. His face is at this time exceedingly red, his skin 
hot, and fury bursts forth on the slightest opposition. These symptoms in- 
crease during the night. We multiply lotions of oxycrate upon the head, and 
several tumblers of an emulsion are drank with avidity. We permit the pa- 
tient to walk about naked in the open air, and spunge him with cold water, 
but nothing soothes him. At two o'clock at night, the patient who was asleep 
in bed, overcome by fatigue, is awoke by a frightful dream. He thinks that he 
is surrounded by robbers, and places with difficulty his bed against the win- 
dow to prevent their entrance. At the same time, he utters frightful cries, 
and strikes, with redoubled blows, against the walls and door of his cham- 
ber. I hasten to the patient. Neither my exhortations, nor the presence of 
several attendants could reassure him, or cause him to cease his vociferations. 
His face is very much flushed, the blood-vessels of the neck and head greatly 
enlarged, the skin hot, and his fury extreme. I threaten the patient with 
the douche. He desires, and receives it ; becoming coinposed, while the wa- 
ter is falling upon his head. He thanks us for the favor we have done him, 
retires to bed, drinks several glasses of very cool emulsion, and sleeps finely 
the rest of the night. 30th. Calm. There is however, a wildness of action, 
which seems to be aroused by the genius of destruction. Whilst tearing up 
his linen, he assures me, that he is making shirts, sheets and mattres.ses. 
The vesicatory discharges, although it was often plucked off. A bitter and 
laxative ptisan. 

July 1 St. Return of his cries, agitation and fury. Lotions of vinegar and 
water applied to the head and the whole body, are followed by sleep. 3d. Fu- 
runcles upon the back and arm ; composure, sadness, tears ; less delirium, 
but the same desire to use and exercise his hands; diarrhcea. 5th. Symptoms 
again exasperated. They are temporary, and during their continuance, his 
face is very red. 8th. Application of leeches to the anus. The vesicatory 
and several boils dry up, from the impossibility of employing dressings upon 
them. 9th. Composure and agitation alternate. He destroys every thing ; 
demolishing, he says, to build again. He breaks, in order to make new ob- 
jects. He roots out the trees, in order to quicken vegetation. He tears up 
his linen, in order to increase the quantity of it. He marries himself to se- 
ven or eight women, and is noisy during the night. At times, he howls. 
10th. At one o'clock at night, he throws against his door, the wood-work of 



190 CRITICAL TERMINATIONS OF INSANITY. 

his bed, which is of great weight. We come to the patient, and find him 
pale, trembling and frightened. He thought he had seen four robbers, who 
wished to enter his chamber. We encourage him, wet his head and spunge his 
whole body with very cold vinegar and water. He then goes to bed, and sleeps 
perfectly well the rest of the night. 12th. Tepid baths, douches every other 
day ; composure, lucid moments, and sleep. Towards the end of the month 
his agitation returns, always preceded by palor, and accompanied by redness 
of the face, heat and thirst. The blister has dried up, and the boils ceased 
to suppurate. The diarrhoea has also ceased. 30th. Lucid moments, walks 
abroad. The patient tears less, remains clad, eats with propriety, but at break 
of day, overturns every thing in his chamber. Tepid baths, aloes, and pow- 
dered rhubarb, mingled with pulverized orange leaves. 

Aug. 20th. Several boils appear ; same treatment ; bitter drink. 27th. 
Manifest progress towards the use of the reason ; patient writes to his wife. 
30th. Abundant suppuration of the boils, and sleep. The patient no longer 
tears, but every morning his bed is overturned. 

Sept. 4th. Redness of face, agitation, delirium, impatience. The boils 
discharge a little ; return of strength. 13th. New boils, composure, scarcely 
any delirium. 21st. Abundant suppuration of the boils. The patient enjoys 
the perfect use of his reason, desires to see his wife, and speaks of returning 
home. 29th. Agitation, tears, extravagant notions, abundant stools. Laxa- 
tives in combination with bitters, and alternating with tepid baths. 

Oct. 11th. Reason perfect, memory somewhat enfeebled; face flushed at 
times ; slight embarrassment in speech ; step slow and uncertain. The boils 
begin to dry up. Takes exercise both by walking and in a carriage. Peru- 
vian bark and sack. Issue upon the arm. 

Nov. Reestablishment of the vital forces, muscular movements easy, gay- 
ety, and social civilities. 25th. Arrival of his wife. He was more sad and 
thoughtful on the following days. Every evening his eyes are red, and his 
head aches. 28th. Slight paralysis of the tongue ; dissipated by exercise and 
labor in the garden. Foot baths, rendered stimulating by mustard, employed 
for several days in succession ; purgative enemata. Leeches to the anus on 
the 29th. 

Dec. Vesicatory to the neck, which has discharged for some days. Infu- 
sion of arnica. Health perfect. The patient leaves for the country on the 
following month, during a very cold period. His carriage is overturned, and 
falls many feet without his reason being in the least affected by this violent 
shock. Five years afterwards, M. de T., whose hemorrhoids discharged abun- 
dantly, and who enjoyed excellent health, died suddenly, from a cerebral he- 
morrhage. 

A lady, twenty-seven years of age, of a lymphatic temperament, having 
light hair, and a mild, though decided disposition, the issue of a mother whose 
ideas and schemes had always been exaggerated, has been nursing for three 
months. Her husband is obliged to be absent. From that evening, she wor- 
ries and torments herself respecting him. Now, she fears that he is slain ; 
now, that he is going to abandon her. On the following day, her friends, 
wishing to divert her, write for her to visit them. Scarcely has she complied 
with this invitation, before she begins to seek her husband every where, and 
suffers from the most violent delirium, which his arrival does not dissipate. 
After a delirium of three months' duration, which is often attended with fury, 
the patient is committed to my care. She is in a state of religious melancho- 
ly, having a pale face, convulsive features, and rarely speaking. She eats 
little, and with difficulty. Constipation is obstinate. The patient is unwil- 
ling to take any remedy, but desires to die, and invokes death. I order a ve- 
sicatory to the neck, which she supports but a few days. We have recourse 
to mild purgatives. After three months, reason is restored, but the patient 



CBITICAL TERMINATIONS OF INSANITY. 191 

remains gloomy, sad, diffident, jealous and choleric. Nevertheless, she re- 
turns to her family. After some days, an enormous furuncle appears upon the 
perinaeum. Suppuration is very abundant for fifteen days, and from that time, 
her health is perfect. 

Abundant suppurations, whether spontaneous or provoked ; the reopening 
of ulcers and issues, have also, sometimes terminated insanity.* 

M. C, an officer of the guard, twenty-five years of age, very tall, of a fee- 
ble constitution and nervous temperament, of a melancholy disposition, unac- 
quainted with every thing but the service, flying society, and giving himself 
up to solitary pleasures, had seen his brother perish in Egypt, in consequence 
of traumatic tetanus. From the time of his return to France, he remains 
attached to the military service. The death of his father, together with some 
domestic trials, render him more gloomy for a year. About the month of 
March, 1801, whilst exercising, he experiences a peculiar disturbance in his 
stomach, and since that period, he has never ceased to complain of the epi- 
gastric region. He grows lean, and becomes feeble. He believes that his 
lungs are affected, and employs several remedies. 

July 27th. Being at the military hospital, he remains for twenty-four hours, 
sitting upon his hams in bed, unwilling to leave it. At six o'clock on the fol- 
lowing morning, he deceives the overseers and sentinels of the hospital, and, 
clothed with a single garment runs through the streets, drinks a glass of bran- 
dy, betakes himself to the house of a cousin, and is there very delirious. 
Two days afterwards, feeling very thirsty, he drinks ten bottles of wine, in 
which he dissolves several pounds of sugar. He vomits abundantly, but still 
drinks. His servant tries to prevent it, but this is not done without danger. 
In the evening, he experiences great prostration, and during the night suffers 
from convulsions, when his urine is discharged involuntarily. His thirst is 
most urgent. On the following day, the delirium is continued and general. 
He spits at every one, often becomes furious, and thinks that every thing of- 
fered him is poisoned. 

Aug. 20th. I visit the patient, who is at the Guard hospital. I find him 
bound to his bed, surrounded by his comrades, pale, extremely emaciated, his 
eyes glazed, the muscles of his face wan, and his breath exhaling a fetid odor. 
I cause him to be unbound, and he consents to enter a carriage with me alone. 
The open air composes him, and he is rational. Having been introduced to 
his new habitation, he sleeps for several hours. On waking, there is redness 
of the cheeks, his eyes are fixed, and his physiognomy sad. " I could die 
for him ; I must see him ; if he sees me, every thing is saved ; he is God, my 
father ; my mother ! he has chosen my mother for his wife. In the name of 
the Father and of the Son and of the Holy Ghost. So may it be." These 
phrases are blended together, during seasons of repose, when the patient seeks 
for words, and repeats them very rapidly, as if after a great effort of memory. 
He often makes the sign of the cross, pronouncing the words, "/« the nume^ 
etc., in a slow and solemn manner. The pupils are dilated, and the urine 
flows involuntarily. Perspiration is general, limbs rigid, pulse feeble and sub- 
sultus tendinum. Lotions of cold water to the head, and sinapisms. 21st. 
A remission, attended with a general sense of feebleness. He seeks every 
where for his father and mother. There is tetanic rigidity. Signs of the 
cross are constant, and he entertains solicitude respecting his life. At evening 
he has an appetite, and a remission of his malady. The patient sees 20,000 
men pass, on horseback, borne upon clouds, to the conquest of England. 
During the night, there is tetanic rigidity, and an expression of alarm upon 
his countenance. The patient believes that he sees devils, from which he 
tries to rid himself by signs of the cross, and blows of his fists which he 

* Sibbern. in Collect. Soc. Med. Havn. I, no. 11. 



192 CRITICAL TERMINATIONS OF INSANITY. 

makes in the air. 23d. From seven o'clock in the morning, there is tetanic 
rigidity ; his eyes are fixed, and the pupils dilated. There is perspiration, 
slow pulse, and insensibility when the skin is pinched. The visit of a com- 
rade causes the tears to flow. Alcoholic frictions are employed, a blister to 
the neck, and sinapisms to the feet. 24th. Same delirium, complaints of 
the patient as to what he is caused to suffer ; tetanic rigidity diminished. Ve- 
sicatory discharges abundantly. 25th. Bath, followed by sleep. The sight 
of his sister afforded him the sincerest pleasure, but after his first greetings, 
he sinks into a profound sleep. All the articulations of the fingers, upon 
which blisters were formed day before yesterday, are in a state of suppuration. 
27th. The patient is stronger, and desires to be left to take care of himself. 
28th. He affronts his sister, and is at times delirious. Gayety and sadness 
alternate. Sleep. 

Sept. 4th. We open a blister under the heel, formed by the sinapism on 
the 2;3d of Aug. ; an operation which the patient was unwilling to permit. 
The serum which is poured forth, exhales an exceedingly fetid odor. A few 
drops of it fell upon one of my fingers, causing a whitlow, which it was ne- 
cessary to open with an instrument. 5th. A complete remission, together 
with a bath. 6th. Abundant stools, bleeding at the nose, and perspiration. 
The wound upon the heel is of an unhealthy character. New blisters form 
upon all the fingers. 17th. Same state continues; severe and continued 
pains at the epigastrium. 27th. The blisters of the fingers dry up succes- 
sively. The wound beneath the heel improves. Milk, chocolate, tonics. 

Oct. 2d. Cicatrization of the wound of the heel. Since this period, al- 
though the patient makes a visit to his relatives and friends, and walks much, 
he becomes sad, uneasy, impatient. Nothing diverts him, and he says he 
suffers greatly. 11th. His emotions are variable. There is alternately, gay- 
ety and sadness, discouragement and bitter complaints. We apply a blister 
to the arm, and administer purgative drinks during several days. Stools abun- 
dant. 13th. Restoration to health. It is remarkable, that during the sup- 
puration of the vesicatory, the patient improved daily. 23d. This young 
officer leaves for his family in the country, and a few days afterwards, there 
was a suppression of the vesicatory. His health immediately suffers, and an 
issue is established. M. C. at length returns to his service, from which he re- 
tires a year subsequently, at the solicitation of his relatives, in the enjoyment 
of ofood health. 

A lady, forty years of age, becomes a maniac, and remained so for a year. 
After an intermission, she had another attack, which persisted for a year ; 
and so on, for twenty years. At the time of the cessation of the menses, a 
cancer appears on the right breast, and at the age of sixty years the tumor 
is extirpated. An attack recurs, without affecting the tendency of the wound 
towards cicatrization, which took place six weeks after the operation. When 
the wound had cicatrized, the attack which usually lasted a year, ceased en- 
tirely, and very speedily, having continued only six months ; and has not 
again returned. For seven years, this woman has enjoyed perfect health.* 

Mary Ann Frances F., nineteen years of age, of a nervous temperament, 
medium stature, light hair, black eyes, light complexion, and a moderately full 
habit, was born of an insane mother. At seven years of age, she has variola, 
at twelve tinea capitis, at thirteen psora, at fourteen, the menses, preceded by 
an eruption on the head. Since the turns have been abundant, she has had 
frequent attacks of headache. At the age of sixteen years, she imagined 
that every one was watching her movements, but this painful idea was prompt- 
ly dissipated. Married at the age of eighteen, she had at nineteen a happy 
confinement. She desired to nurse her infant, but at the earliest period of 

* Lafontaine. 



CRITICAL TERMINATIONS OF INSANITY. 193 

lactation, committed errors in regimen. She was unwilling to remain cover- 
ed, saying, she was too warm, etc. The conformation of the nipples not be- 
ing favorable for nursing, she experienced much pain whilst the child was at 
the breast, which occasioned great disorder of thought. On the fourth day, 
she ceases to nurse, and her breasts are excessively distended with milk. On 
the fifth, she drinks cold water, and washes herself in it. The lochia cease, 
and the delirium increases. She complains of an insupportable heat. They 
cannot bleed her. She pinches and bruises her breasts without appearing to 
suffer. On the fourteenth day, leeches are applied to the vulva, mustard to 
the thighs, and two blisters to the legs. On the sixteenth day, leeches are 
applied behind the ears, sinapisms anew, ethereal potions, etc. All these 
means were employed without success. On the 25th Feb., she is brought to 
La Charite, and after remaining there four days, is transferred to the Salpe- 
triere. On her arrival, the delirium is general, the breasts are very hard, and 
the patient refuses to remain covered. She is, without cause, tormented with 
fear, mistaking persons who approach her, for gentlemen of her acquaintance. 
March 5th, a milk abscess forms in the right breast, which was previously 
very hard and of a violet color. An abundant discharge of sanious matter 
takes place, yet the delirium continues, and the patient will allow no apparel 
to be put upon her. April 10th, the opening in the breast tends to cicatriza- 
tion, the delirium lessens, and the patient regards the advice that is given her. 
Laxative drinks. May 1st. Progressive return of the vital forces, and rea- 
son. Sees her husband and parents : is more calm and rational. May 12th. 
Entire convalescence, and complete cicatrization of the abscess. 15th, rea- 
son is wholly restored. On the 27th, our convalescent is discharged cured. 

We have had at the Salpetriere a woman, thirty-five years of age, who was 
affected with a monomaniacal delirium, attended with excessive mobility. She 
had a cancer in a state of ulceration on the left breast, showed it to every one, 
and would wear no apparel. The surgeon-in-chief of the hospital. Professor 
Lallemand, extirpated the breast ; an operation which the patient bore with 
great fortitude. From that moment, she was more composed, and willingly 
submitted to the employment of dressings. Although enormous, the wound 
healed rapidly ; and cicatrization and the reestablishment of reason were 
simultaneous. 

A woman forty-five years of age, had for three years, an ulcer upon the 
leg. They heal the sore, and she immediately becomes a maniac, and suffers 
somewhat from difficulty of articulation. She is brought to the Salpetriere. 
The ulcer is reopened, and reason restored. Similar facts have been present- 
ed to my notice, seven or eight times at least, in the course of my practice. 
We have in the division for the insane at the Salpetriere, a woman forty-six 
years of age, affected with an attack of mania without fury, which was induced 
by a thunder-clap. This attack terminated in an engorgement of the sub- 
maxillary glands of the right side. The patient then fell into a stupor, attend- 
ed with an inability to articulate sounds. The use of mercury internally, and 
friction to the tumor, dissipated the engorgement. This woman recovered 
her reason, in proportion as the glands were emptied, and at length, became 
sane. But scarcely had she returned home, than she experienced domestic 
mortifications and distress, and relapsed into a state of stupor and paralysis. 
The glands were engorged anew, and since they have been relieved a second 
time, the patient is better. 

Elizabeth C, sixty-four years of age, of much constitutional vigor, and very 
active for one of her age, has always enjoyed excellent health. She never 
experienced any menstrual disorder, and had four fortunate confinements. 
One of her sons went to Spain during the last war. Having received no in- 
telligence respecting him, she thought she recognized him one day among a 
company of soldiers, and followed this company from the suburb St. Antoine, 

25 



194 CKITICAL TERMINATIONS OF INSANITY. 

to the environs of the barrier Fontainebleau. We know not precisely what 
happened on the way, but she was taken by the police, on the following day, 
running naked through the streets and public places. She is brought to the 
Salpetriere, in a state of agitation extraordinary for a person of her age. 
This condition lasts for six weeks without any remission ; when at length, the 
parotid of the left side becomes developed. The delirium is immediately as- 
suaged. The repeated application of leeches to the tumor, reduced its in- 
flammation. However, an abscess forms, which is opened and cured in the 
course of about three weeks. Ever since the enlargement of the parotid com- 
menced, the delirium has gradually lessened, and finally disappeared before 
the cicatrization of the wound, formed by the opening of the abscess. At this 
time, June 24th, the patient leaves the hospital perfectly restored. 

Sputation is a very remarkable symptom among the insane. It often an- 
nounces the explosion of an attack, and sometimes persists during the whole 
period of the malady. There are insane persons who make all the efforts and 
movements of one who desires to spit, though they are unable to accomplish 
the act. This desire seems to result from an obstruction of the throat, or a 
constriction of the salivary glands. Salivation is sometimes very abundant, 
even among very meagre subjects. Certain German authors assert, that this 
symptom is the sign of an affection of the liver ; but I have never been able 
to demonstrate this fact. Salivation is the effect of atony and paralysis in the 
case of individuals who are in a state of dementia, and who allow a great 
amount of mucus to flow from the mouth, unperceived by them. Abundant 
salivation sometimes terminates insanity. When the insane are phthisical, if 
spitting is suppressed, the delirium increases, and excitement or sadness is 
more considerable. When the spitting is abundant, there is a remission of 
insanity. The skin performs its functions imperfectly in insanity, and there- 
fore, the reestablishment of the transpiration concurs, more frequently than is 
supposed, in the cure of the insane. Is it not to this cause that we are to at- 
tribute many cures in spring, and the good effects of tepid and vapor baths, 
together with mucilaginous drinks ? Perspiration sometimes terminates insa- 
nity. This termination is more rarely observed, on account of the agitation 
of the patient, but is frequent. Do not the heats of summer, by provoking 
abundant sweats, favor the cures of autumn ? By means of these, in connec- 
tion with the vapor bath, I have cured some insane persons. Tears, which 
perform an important part in the ncrvotis disorders of women, also terminate 
insanity. 

A lady, thirty-four years of age, of a lymphatic temperament and nervous 
constitution, and of a mild and timid disposition, has always enjoyed good 
health, although the menstrual flux is not regular. For some months she 
takes care of a lady whom she tenderly loves. She labors day and night, and 
watches for fifteen nights in succession. Whilst greatly and constantly trou- 
bled, through fear of seeing her friend perish, she learns that her lover has 
fought a duel, and been wounded. After concealing her despair for some 
hours, she becomes delirious, and reveals her secret. They bleed her, and 
prescribe foot-baths and diluent drinks. After fifteen days, the violence and 
agitation are subdued. The patient is conscious that during her delirium, 
she has revealed the secrets of her heart. From this period, she believes her- 
self despised by every one, detested by her husband, and destined to some 
punishment. She desires to die. Five days are spent in vain solicitations to 
induce her to take some aliment, and for eight days, she takes but a few swal- 
lows of broth. She is committed to my care. The countenance of the pa- 
tient is pale, the lips brownish, eyes dull, the physiognomy expressive of pain, 
and the movements slow. At times, she heaves a profound sigh, her breath 
is fetid, and she sufters from constipation. On the day after her admission, 
I place with the patient, beside the women who serve her, a young lady of an 



CRITICAL TERMINATIONS OF INSANITY. 195 

agreeable exterior, mild and engaging, who converses at first, with an air of 
indifference, then with an accent of benevolence and friendship, and at length, 
commits to her certain confidential matters, and invites our patient to unfold 
her feelings. After twenty -four hours of gentle and adroit perseverance, the 
patient takes the hand of her new friend, sheds a torrent of tears, and then 
reveals all the secrets of her heart ; pointing out the cause of her delirium, 
the motive that induced her to resolve to eat no more, in fine, the fears that 
harass her. She decides also, to take some nourishment. On the day fol- 
lowinor, there is a new struggle against her notions, resolutions and fears ; a 
new crisis, a new effusion of tears, and progress towards convalescence. Af- 
ter three weeks the cure is completed, on my assuring the patient that no- 
thing that she had said was believed, but had been attributed to her delirium. 

This crisis, which we often observe in hysteria, is more frequent among 
melancholies than maniacs. I remarked, page 58, that insanity is terminated 
by the spontaneous vomiting of mucous matters, yellow and brownish. These 
terminations are so frequent, and so commonly useful, that they have served 
as a guide to practitioners who, wishing to imitate nature, and follow her ten- 
dencies, have, at all times, made use of emetics. I have averted, so to speak, 
attacks of insanity, by giving emetics, and prevented threatening relapses, by 
the administration of even drastic purgatives. These therapeutic agents are 
not always employed to unload the alimentary canal. Their action is some- 
times perturbating. It overcomes the spasm of the intestines, or determines 
a revulsive irritation, which is in some cases salutary. Insanity is sometimes 
terminated by coition, and even onanism ; although these two causes often 
produce this malady, which then passes speedily into dementia. Every body 
knows the history of M. Bl., rector of Reole, related by himself This pa- 
tient, who was strong, robust, and in the flower of his age, consecrated both 
by occupation and principle to the severest continence, becomes a maniac, 
and is cured at the expiration of six months, after a very abundant and spon- 
taneous spermatic evacuation.* 

We have often seen girls, and young widows, cured by marriage. Alexan- 
der Benoit states, that a maniac, escaping from her house, entered a lodging 
room, where she was subjected to the brutality of 15 individuals. Her men- 
ses, which had been suppressed, were reestablished, and the patient was cured. 
I understand, from a physician who has charge of the insane at Stockholm, 
that a young maniac, having escaped from his cell, enters the habitation of a 
young woman who is insane ; and that, after having given themselves up dur- 
ing the night, to the wildest venereal transports, the former was found on the 
following morning dead, and the latter cured. I have never had occasion to 
observe similar crises in mania; but have sometimes known marriage to cure 
hysterical melancholy I have had charge of three girls who, after attacks of 
mania, remained a long time sad, gloomy and inactive ; and who recovered 
the plenitude of their health only after marriage. We must also take notice 
of moral influences. Pregnancy, confinement and nursing, are means which 
nature sometimes employs, to terminate insanity. I believe these terminations 
are rare. I have often noticed, that pregnancy and confinements changed the 
delirium in no respect, but rendered maniacs more composed. I have also 
known one lady who, during five consecutive pregnancies, became insane, and 
was cured in every instance by confinement.! Notwithstanding these exam- 
ples, and many others cited by numerous authors, and the opinion of many 
physicians, I regard as exceptions, the cures of insanity by marriage, preg- 

* Euffon. Hist, of Man. — Ch. Londe, art. Satyriasis, of the Die. of Practical Medi- 
cine and Surgery, t. xiv, p. 527. — Leuret, Psyc. Fragments on Insanity : art. Passive In- 
spiration, p. 282. 

i An ephemeris of curious things in nature. 



196 CRITICAL TERMINATIONS OF INSANITY. 

nancy and confinement ; so often have I seen it persist, and even aggravated, 
by these means. Let one visit the Salpetriere, and he will there find more 
than one hundred insane women, although they have been married, pregnant 
and confined. 

As the natural secretions may become the causes and crises of insanity, so 
those of a morbid character, may both produce and terminate this malady. 

M. de F., seventeen years of age, of a robust constitution and great 
strength, of a yielding disposition, and addicted to the pleasures of his age, 
contracts a gonorrhcsa, and is treated with the liquor of Van-Swieten. One 
night, being tormented by thirst and want of sleep, he takes a bottle of the 
pure liquor that was standing upon his table, drinks of it, and persuades him- 
self that they wish to poison him. He becomes furious, is cured at the expi- 
ration of three months, and becomes a soldier. Being in the army during the 
campaign in Prussia, (then twenty-four years of age), he gives himself up to 
all the excesses to which his new condition exposes him. He contracts a go- 
norrhoja, and his comrades advise him, in order to cure it, to drink a large 
tumbler of brandy, in which they had steeped the powder of three cartridges. 
The gonorrhoea disappeared. The patient however begins to be delirious, 
yields himself to new excesses, and arrives in France with his regiment. The 
fury and delirium augment. Not recognizing his superiors and comrades, he 
commits all sorts of extravagances at his quarters, and is committed to my 
care in the month of May, 1807. This young officer is tall, his hair black, 
harsh and abundant, his breath fetid, and his tongue very white. His features 
are shrunken, face pale, and the cheeks flushed. His eyes glisten, emaciation 
is considerable, and there is fury, attended with a desire to rend. His deliri- 
um is general. Now, the patient believes he sees in the clouds a body of 40 
or 50,000 men, which the emperor reviews; now, he thinks himself in an en- 
chanted place, and destined to figure in great events ; becoming proud and 
arrogant. He often sees, through a little opening in the ceiling of his cham- 
ber, immense regions inhabited by beings who are extremely happy, and who 
come and arrange themselves around it, to pay court to him. He regards his 
attendant as the god of the infernal regions ; and whenever he sees him shut 
a door, he thinks that the gates of Erebus are forever closed upon him. 
Another is his guardian angel, who is often overcome by the god of hell. His 
sleep is a long time troubled by the sight of a skeleton, which rises from the 
floor to the ceiling of his chamber, and upon which my patient throws himself 
with fury, uttering loud cries, to rid himself of this unwelcome visitor. He 
tears the coverings of his bed, his mattress and straw bed. He sometimes 
happens to sleep quite naked upon the straw, and on being pricked by it, ima- 
gines that the extremity of every stalk is the beak of an eagle which is going 
to devour him. He then makes upon the floor a clean, circular place, around 
which he arranges the straw, and the remains of whatever he has torn in pieces 
or broken; places himself in the centre of this circle, and moving his head, 
with extreme rapidity from right to left, passes the whole night in blowing, to 
protect himself from the attacks of these eagles. This insomnia, together 
with the apprehensions which maintain it, persists for fifteen nights. After 
having passed six months, in a state of fury which nothing can calm, either 
night or day, he gives himself up to the practice of masturbation, to a fright- 
ful extent, for fifteen days. Representations of its effects, and threats, are of 
no avail. At length, the patient becomes frightened at the dangers that may 
happen from a continuance of these ruinous practices. He is more composed, 
yet we observe that his linen is still soiled. The gonorrhoea has reappeared, 
and I favor this discharge by all possible means. By slow degrees, the patient 
becomes more calm and tranquil, and more accessible to the councils of rea- 
son. It is at about the eighth month, that we began to regard him as fairly 
convalescent. There still remains some confusion of ideas, uneasiness, preju- 



CRITICAL. TERMINATIONS OF INSANITY. 197 

dices, and an apathy difficult to overcome. I oblige him to occupy his mind, 
and to go abroad with a convalescent like himself. He is immediately seized 
with another attack of gonorrhcEa, which lasted more than three months. 
Since that time, he has been well. Two years afterwards, he suffers from a 
third attack of gonorrhcEa, which he suppresses, and the inguinal glands be- 
come engorged. He loses his reason, and throws himself from a third story, 
not for the purpose of destroying himself, but under the influence of an illu- 
sion. The noise which he makes, draws together a crowd of people in the 
court of the hotel, where he stops. Persuading himself that it is a body of 
the enemy, he mounts his horse upon the balcony of his chamber, and exclaims 
with the tone of a commander ; charge, forward. He advances suddenly, 
falls upon the pavement, and escapes with some contusions. The glands sup- 
purate abundantly, and after a month, during which the delirium progressively 
diminishes, M. de F. is quite rational. 

Physicians have observed that the pain of the first dentition, causes St. 
Vitus' dance. Among subjects of a lymphatic and nervous temperament, it 
sometimes becomes also, the cause of insanity. The appearance of the teeth 
through the gums, causes all the symptoms to cease. I have observed this, in 
the case of three young women. They have convulsions, bloating of the face, 
discharge much saliva, and often raise their hands to the mouth. They com- 
plain of great pain in the head and jaw. I could not be deceived respecting 
the cause of this malady, in the first of the three patients. The delirium 
ceases at the expiration of a month ; and two teeth had pierced their enve- 
lopes. Fifteen days afterwards, mania reappeared with the same intensity. 
The gums of the late teeth were swollen and very red. The attack lasted 
several months and ceased only on the appearance of the teeth. 

[I cannot refrain from referring in this place to the remarks of Doctor Marshall Hall 
on this important subject (dentition), and quoting from the Lancet of May 18th, 1844, 
a paragraph from his pen. Though they refer especially to children, the cases before us 
show, that they are, sometimes at least, applicable to those who are rapidly approaching, 
if they have not already reached the period of maturity. " Like other physiological pro- 
cesses," he observes, "it is apt to become, from its very character of energy, patholo- 
gical, or of morbid activity. It is obviously then, attended with extreme suffering to the 
patient; the brain is irritable, and the child is restless and cross; the gums are tumid 
and heated ; there is fever, an afiection of the general vascular system, and there are too 
frequently, convulsions of various degrees and kinds, manifested in the muscles that 
move the eyeball, the thumb and finger, the toes; the larynx, the parietes of the respi- 
ratory cavities ; and the limbs and frame in general, affections of the excito-motor part 
of the nervous system, and of the secretions of the liver, kidneys and intestines, affec- 
tions of the ganglionic division of that system."] 

Perhaps I ought to have incised them, although this would have been by no 
means easy ; the patient being very much agitated, and believing that we wish- 
ed to assassinate her. 

[The reason assigned by our author for not performing immediately the operation 
strongly urged by Dr. Hall, viz., incising the gums, repeatedly if necessary, is one that 
strikes us as puerile, unless perhaps, it may be attributed to extreme sensibility and be- 
nevolence of heart. I should not however, have referred to this point, had I not else- 
where observed a want of the same qualities of firmness and resolution in administering 
food, at times when the patient stood in imminent danger of complete and fatal exhaus- 
tion. God forbid that I should recommend a measure, however trifling its character, 
that would cause a patient alarm, or indeed any degree of apprehension, without a cor- 
responding or far greater good. Yet to permit him to starve, or a paroxysm of mania to 



198 CRITICAL TERMINATIONS OF INSANITY. 

continue for months, when the use of the stomach pump in the one case, and the gum 
lancet in the other, might liave prevented these grave issues, is not humanity, but a 
cliildish wealiness.] 

I shall close this article with the following case, extracted from the Giornale 
delle Scienze Medicalc cli Napoli, by M. de Renzi. A maniac, thirty-three 
years of age, of a bilious temperament and strong constitution, had an enor- 
mous tumor on the nates of the left side, extending even to the anus. It was 
opened with a sharp instrument, and discharged a great quantity of fetid mat- 
ter. The wound was dressed with cerate and an emollient cataplasm. Gan- 
grene appeared, and the dressing was made with storax. The patient was put 
upon the use of lemonade. During the suppuration, the attacks of fury were 
less frequent, and some signs of returning reason were observed. When the 
eschar was removed, a fistula in ano was found to exist, and was treated me- 
thodically. In proportion as the ulcer cicatrized, the reason of the patient 
improved. The cicatrization of the fistula was complete in forty-five days 
after the operation. Reason was reestablished March 2d, 1835. This pa- 
tient was admitted into the hospital for the insane at Palermo, Dec. 19th, 
1834. 

Such is an enumeration of the most remarkable physical crises of insanity. 
I could have multiplied the details, have added a greater number of examples, 
and hazarded some explanations ; but I have limited myself to unfolding those 
practical results which are justified by the testimony of authors. We may 
arrange the crises of insanity in the following order ; fevers, hemorrhages, 
gastric phlegmasia?, cutaneous affections, and those of the lymphatic system. 
It is the duty of the practitioner, to distinguish the different tendencies of na- 
ture, and to second them according to the precept of Hippocrates. We have 
seen insanity terminated after a fall upon the head, by poisoning, by the cut- 
ting of the hair, by the operation for cataract, and by castration. Doctor 
Ziitzin, a physician at Bamberg, observed that three attacks of mania were 
terminated by plica ; and by appropriate treatment, prevented for seven years, 
the return of the attacks. These however, are facts rather curious than use- 
ful, which are isolated, and can never furnish any therapeutic view, nor guide 
the physician in the treatment of mental alienation. 



LYPEMANIA OR MELANCHOLY. 



Definition of terra, both ancient and modern, with remarlvs. — No advancement in science 
or the arts, which has not served as a cause of mental disease. — Monomania has its 
seat in the heart of man. — A disease especially of civilization. — Modified by state of 
society. — Illustrations. — Tristimania of Rush, lypemania or melancholy of Esquirol. — 
Views of the ancients respecting melancholy. — Symptoms of lypemania or melancho- 
ly. — Description of the person of a lypemaniac. — Cases. — Great torpor of the secre- 
tions. — Aversion to food. — Loss of rest in consequence of hallucinations and illusions. 
— Dreams terrify many. — Secretions become greatly disordered. — Urine. — General 
description of the emotions of the lypemaniac. — Modifying influence of the passions 
on the mind. — Causes of lypemania. — Seasons and climates. — Spring and summer 
produce the greatest number of lypemaniacs. — Table illustrative. — Spring most favora- 
ble to the cure of lypemania. — Age. — Childhood. — Adolescence. — Maturity. — Old age. 
— Table of ages. Sex. — Temperaments. — Professions and mode of life. — Table of 
causes. — Lypemania is continued, remittent, or intermittent. — Remittent form most 
common. — Crises very numerous. — Diseases which cause the death of lypemaniacs. — 
Post-mortem examinations. — Most frequent termination, phthisis pulmonalis. — Patho- 
logical anatomy has taught us nothing positive, respecting the seat of melancholy. — 
Table of diseases totvhich lypemaniacs succuvib. — Displacement of the transverse colon 
frequent. — Interesting case and post-mortem examination. — Other cases with autop- 
sies. — Table of the -pathological lesions found in the post-mortem examination of one 
hundred and sixty-eight cases of hjpemania. — Treatment of lypemania. — It may be 
hygienic, moral or pharmaceutic. — Influence of atmosphere on health and disease. — 
Case, reported in the language of the sufferer, together with the advice given. — Cloth- 
ing. — Food. — Exercise both of body and mind recommended and enforced. — Isolation. 
— Tepid baths. — Continence and sexual intercourse. — The passions. — Fear. — Supersti- 
tion. — Love. — Means used to break the chain of morbid feelings. — Examples. — Music. 
— Physical treatment. — Laxatives, and at the commencement of an attack, emetics 
and emeto-cathartics. — ^Tartrate of Antimony and Potassa with drastics, to be employ- 
ed under certain circumstances. — The rotatory machine. — Blood-letting, local and gene- 
ral. — Baths ; tepid, vapor and cold. — Affusions. — Douche. — Internal exhibition of cold 
water. — Opium. — Magnetism. — Closing remarks. — {Farther remarks on treatment.) 

Writers, since the time of Hippocrates, have denominated that form of 
delirium which is characterized by moroseness, fear, and prolonged sadness, 
Melancholy. The appellation, melancholy, has been aiven to this variety of 
insanity, according to Galen, because the depressing moral affections depend 
upon a depraved condition of the bile, which, having become black, obscures 



200 LYPEMANIA OR MELANCHOLY. 

the animal spirits and produces delirium. Some moderns have given a more 
extended signification to the word melancholy, and have called melancholic, 
every form o^ partial delirium, when chronic, and unattended by fever. It 
is certain that the word melancholy, even according to the acceptation of it 
among the ancients, often presents to the mind a felse idea ; for melancholy 
does not always depend upon the bile. Nor would this signification be suited 
to it, as the moderns define it. This double consideration, has caused me to 
propose the word monomania; (derived from novo;, alone, and fjnpia, mania;) 
a term which expresses the essential character of that form of insanity, in 
which the delirium is partial, permanent, gay or sad. This generally received 
definition is now adopted by the greater number of physicians, and is estab- 
lished in our language.* The word melancholy, employed in the language 
of common life to express that habitual state of sadness from which some 
people suffer, should be left exclusively to moralists and poets, who, in their 
expressions, are not obliged to employ so much precision as physicians. Its 
signification should be limited to the temperament in which the hepatic sys- 
tem predominates, and to designate the disposition to a fixedness of ideas, and 
sadness ; while the word monomania, expresses an anormal condition of the 
physical or moral sensibility, with a circumscribed and fixed delirium. 

Monomania is of all maladies, that which presents to the observer, pheno- 
mena the most strange and varied, and which offers, for our consideration, 
subjects the most numerous and profound. It embraces all the mysterious 
anomalies of sensibility, all the phenomena of the human understanding, all 
the consequences of the perversion of our natural inclinations, and all the 
errors of our passions. He who is profoundly versed in whatever relates to 
monomania, cannot be a stranger to that knowledge which relates to the pro- 
gress and course of the human mind. It is also, in direct relation in point of 
frequency, with the development of the intellectual faculties. The more the 
understanding is developed, and the more active the brain becomes, the more 
is monomania to be feared. There has been no advancement in the sciences, 
no invention in the arts, nor any important innovation, which has not served 
as a cause of monomania, or lent to it, its peculiar character. The same is 
true of the prevailing notions, general errors, and universal convictions, whe- 
ther true or false, which impress a peculiar feature upon each period of social 
life. Monomania is essentially a disease of the sensibility. It reposes alto- 
gether upon the affections, and its study is inseparable from a knowledge of 
the passions. Its seat is in the heart of man, and it is there that we must 
search for it, in order to possess ourselves of all its peculiarities. How many 
are the cases of monomania, caused by thwarted love, by fear, vanity, wound- 
ed self-love, or disappointed ambition ! This malady presents all the signs 
which characterize the passions. The delirium of monomaniacs is exclusive, 
fixed and permanent, like the ideas of a passionate man. Like the passions, 
monomania now manifests itself by joy, contentment, gayety, exaltation of the 
faculties, boldness, and transports of feeling ; now, it is concentrated, sad, 
silent, timid and fearful ; but always exclusive and obstinate. 

It has long been said, that insanity is a disease of civilization ; it would 
have been more correct to have said this respecting monomania. Monoma- 
nia is indeed frequent in proportion to the advancement of civilization. It 
borrows its chararter, and finds again the causes which produce it, in the dif- 
ferent periods of society. It is superstitious and erotic in the infancy of 
society, as it is also, in the countries and regions where civilization and its 
excesses have made little progress ; whilst in an advanced state of society, 
its cause and character manifest themselves in, and depend upon, pride, scep- 

** This word has been admitted into the Dictionary of the French Academy, edition 
of 183.5. 



LYPEMANIA OR MELANCHOLY. 210 

ticism, ambition, the passion for gaming, despair and suicide. There has 
been no social epoch, which has not been remarkable, in consequence of 
some indications which monomania furnishes, of the intellectual and moral 
character of each. 

The state of modern society has modified the causes and character of mo- 
nomania, and this malady now reveals itself under new forms. With the 
weakening of religious convictions, demonomania, and forms of insanity de- 
pending upon superstition, have also disappeared. The influence of religion 
over the conduct of people being lessened, governments, in order to maintain 
authority over men, have had recourse to a police. Since that period, it is the 
police that troubles feeble imaginations, and establishments for the insane are 
peopled with monomaniacs who, fearing this authority, are delirious respecting 
the influence which it exercises, and by which they think themselves pursued. 
This monomaniac, who would formerly have been delirious with respect to 
magic, sorcery and the infernal regions ; is now delirious, thinking himself 
threatened, pursued, and ready to be incarcerated by the agents of the police. 
Our political convulsions, in France, have been the occasion of much mono- 
mania, which has been provoked and characterized by events which have 
signalized each epoch of our revolution. 

To the facts stated at page 17, 1 will add the following : In 1791 , there were 
at Versailles, a prodigious number of suicides. Pinel states, that an admirer 
of Danton, having heard him accused, became insane, and was sent to the 
Bicetre. At the death of the king and his unfortunate family, much mono- 
mania immediately made its appearance. The trial of Moreau, and the death 
of the duke d'Enghien, produced much of it. When the pope visited France, 
this great event awoke anew religious ideas, and there was then much super- 
stitious monomania, which disappeared immediately. At that epoch, when the 
emperor peopled Europe with new kings, there were in France many mono- 
maniacs who thought themselves emperors or kings, empresses or queens. 
The Spanish war, the conscription, our conquests and reverses, produced also, 
their mental maladies. How many persons, stricken with terror at the time 
of the two invasions, remained monomaniacs! Indeed, we now find in mad- 
houses, many persons who consider themselves dauphins of France, and des- 
tined to the throne. Many cases, which we may read in this work, will con- 
firm this general truth ; that the state of society exercises a striking influence 
over the production and character of monomania. The profound study of 
this disease, allies itself to an acquaintance with the morals and habits of 
every people. The gymnosophists destroyed themselves in consequence of 
their contempt of death ; the stoics through pride, and the Japanese through 
love of virtue. Monomania took the form of superstition among the Jews as 
it exists at this day in Spain, and in every country in Europe where indiffe- 
rence and incredulity with respect to ancient forms of belief, left minds to 
the influence of the religious sentiment ; from whence spring ideas the most 
strange and absurd. We observe the same in England and Germany, among 
the jealous members of the various sects, which are multiplying almost to infi- 
nity. This observation has been made by all English and German physicians, 
who have written upon mental diseases. Monomania was erotic in Greece, 
as it now is in Italy. The habit of being always on horseback, rendering the 
Scythians impotent, they thought that their sex had been changed. In some 
countries they fear the black devil ; in others the white. There, monomaniacs 
consider themselves bewitched, or wolf-men ; here they fear magicians and 
sorcerers. On the sea-coast, they fear shipwrecks and tempests. These 
forms of insanity still exist, among certain people in the extreme north. 

Such are the general considerations which appertain to every variety of mo- 
nomania, and to all the forms of partial delirium that are permanent, and un- 
attended by fever. But this malady presents itself under two opposite forms. 

26 



^02 LYPEMANIA OR MELANCHOLY. 

The ancients, who had adduced as characteristics of melancholy, sadness and 
fear; were obliged to rank among melancholies certain cases of partial deli- 
rium, which were maintained by an extreme exaltation of the imagination, or 
by passions of a gay and sprightly character. Lorry, who has so well de- 
scribed melancholy, although his definition of it accords with the view enter- 
tained by the ancients, admits a variety of melancholy complicated with ma- 
nia, which is indicated by a partial delirium, attended by exaltation of the 
imagination, or an exciting passion. Rush* divides melancholy into two 
forms ; that in which sadness predominates, which he calls tristimania ; and 
that in which the opposite emotion prevails, which he denominates, amenomania ; 
thus confirming the results of an observation which every one may make. 
Monomania, characterized by a passion either gay or sad, exciting or depress- 
ing, and producing a fixed and permanent delirium, attended also by desires 
and determinations depending upon the character of the prevailing passion, 
is naturally divided into monomania properly so called, which is indicated by 
a partial delirium, and a gay or exciting passion ; and into monomania which 
is signalized by a partial delirium, attended by a sad or depressing passion. 
The first of these affections corresponds with maniacal melancholy, maniacal 
fury, or with melancholy complicated with mania; in fine, with amenomania. 
I give to it the name of monomania, and shall speak of it hereafter. The 
second corresponds with the melancholy of the ancients, the tristimania of 
Rush, and the melancholy with delirium, of Pinel. Notwithstanding the fear 
of being accused of neologism, I give it the name of lypemania, a word 
formed from Ivnetx) tristitiam infei'o, anxium reddo, and fnivia^ mania. We 
shall treat of lypemania in this article, employing indiflferently, the words me- 
lancholy or lypemania, believing that custom has consecrated the latter appel- 
lation. 

Hippocrates designates, as the characters of melancholy, sadness, or pro- 
longed fear, without speaking of delirium. Areteus gives to mania the appel- 
lation of melancholy, so soon as fury is present. Galen adopts and enlarges 
upon this point, as well as upon many other ideas of Hippocrates. Coelius 
Aurelianus does not distinguish melancholy from hypochondria, and relates 
several very interesting cases of partial delirium. Almost all authors who 
have succeeded them, have only copied, or arranged in their own way, the 
ideas advanced by Galen. Rhazes pretends, that the black bile, flowing from 
the spleen into the stomach, produces melancholy. Michaelis of Hereda, 
and Forestus, believe that ideas of a depressing character, and fear, unite with 
partial delirium, to form the distinctive character of melancholy. Sennert 
admits an occult, or obscure condition of the animal spirits, in melancholy : 
Sydenham confounds hysteria with hypochondria, and the latter with melan- 
choly. Ettmuller distinguishes delirium from melancholy ; the former, in his 
opinion, succeeding the affection of melancholy. Frederic Hoffmann and 
Boerhaave, regard melancholy as the first degree of mania. Sauvages defines 
melancholy to be an exclusive delirium, without fury, and complicated with a 
chronic disease. Lorry adopts the definition and theories of the ancients, but 
divides melancholy into three varieties ; one depending upon a material cause, 
one having no such dependence, and a third mixed. Cullen very clearly dis- 
tinguishes melancholy from hypochondria. Li the latter, dyspepsia is present, 
and the delirium relates to the health of the patient. Pinel characterizes 
melancholy, by sadness and fear, with partial delirium concentrated upon a 
single object, or a particular series of objects. Moreau de la Sarthe confines 
himself to the definition of the ancients, and designates this form of madness 
by the title of melancholy with delirium. My honorable friend. Dr. Louyer- 

*Med. Enquiries and Observations upon the Diseases of the Mind. Philadelphia, 
1812, inSvo. 



LYPEMANIA OR MELANCHOLY. 203 

Villermay,* has most clearly pointed out the difference which ouo-ht ever to 
distinguish hypochondria from melancholy. Melancholy consists in the per- 
manent and exclusive impression of any object whatever, pursued with ardor 
and almost always accompanied with fear, suspicion, etc. Such is the defini- 
tion of melancholy which we read in the Treatise on Dclirutm of the respecta- 
ble professor Fodere. The same author gives the name of mania to melan- 
choly, when the latter passes into the state of excitement or fury. 

This hasty exposition, indicates the fluctuation and uncertainty of opinions 
respecting the characteristics and nature of this malady. We consider it well 
defined, by saying that melancholy with delirium, or lypemania, is a cerebral 
malady, characterized by partial, chronic delirium, without fever, and sus- 
tained by a passion of a sad, debilitating or oppressive character. Lypema- 
nia should not be confounded with mania, of which the delirium is oeneral, 
with exaltation of the sensibility and intellectual faculties ; nor with monoma- 
nia, whose characteristic is, exclusiveness of ideas, with a gay and expansive 
passion. It should not also, be confounded with dementia, in which incohe- 
rence and confusion of ideas are the effect of weakness; nor with idiocy, for 
the idiot can never reason. 

Lypemania has been so often taken for hypochondria, that I cannot forbear 
presenting, in few words, the differences which exist between these two mala- 
dies. Lypemania is more frequently hereditary. Lypemaniacs are born with 
a peculiar temperament, the melancholic, which disposes them to lypemania. 
This disposition is strengthened by vices of education, and by causes which 
act more directly upon the brain, the sensibility and intelligence. The causes 
which produce it, are usually moral ; whilst hypochondria is generally the ef- 
fect of physical causes, which modify the action of the stomach, and disturb 
the digestive functions. In lypemania, ideas contrary to reason, are fixed 
and sustained by a depressing passion, as well as a vicious association of ideas. 
In hypochondria on the contrary, there is no delirium, but the patient exagge- 
rates his sufferings. He is constantly preoccupied and frightened at the dan- 
gers which he believes threaten his life : dyspepsia also, is present. 

As in the other forms of insanity, I shall consider, with respect to lypemania 
or melancholy, the causes that produce it, the symptoms which characterize 
it, the course which is proper to it, its terminations and treatment. 



SYMPTOMS OF LYPEMANIA OR MELANCHOLY. 

In person, the lypemaniac is lean and slender, his hair is black, and the 
hue of his countenance pale and sallow. The surface over the cheek bones, 
is sometimes flushed, and the skin, brown, blackish, dry and scaly ; whilst 
the nose is of a deep red color. The physiognomy is fixed and changeless ; 
but the muscles of the face are in a state of convulsive tension, and express 
sadness, fear or terror ; the eyes are motionless, and directed either towards 
the earth or to some distant point, and the look is askance, uneasy and suspi- 
cious. If the hands are not dried up, brown and earthy in their hue, they are 
swollen and livid. 

Mad'lle C, twenty-three years of age, is brought to the Salpetriere June 
8th, 1812. In stature she is of medium size, her hair and eyes are black, the 
eyebrows very thick, and approximate closely at the root of the nose ; her look 
is fixed upon the ground, her physiognomy expressive of fear, her habit of 
body lean, and her skin brown. We observe some scorbutic spots on the 
lower extremities. The hands and feet, always very cold, are of a purplish 
red ; the pulse is slow, and very feeble : constipation, which is ordinarily very 

* Treatise on Nervous Maladies or Vapors. Paris, 1816, 2 Vol., in 8vo, 



204 LYPE MANIA OR MELANCHOLY. 

obstinate, is sometimes replaced by a diarrhoea ; secretion of urine scanty. 
She utters not a word, refuses every kind of movement, and persists obstinate- 
ly in confining herself to bed. We have recourse to various means, to induce 
her to take nourishment. Affusions of cold water triumph over this repug- 
nance, and she eats more readily. However, she manifests at times, her un- 
willingness to take nourishment, though with less obstinacy. For the four 
years that this woman has been in the house, but few words have escaped her, 
which, however, have indicated to us, that fear absorbed all her faculties. 
She formerly lived in the country, and had been excessively frightened by sol- 
diers. We have to oblige her to leave her bed, when, so soon as dressed, she 
sits down upon a bench, always in the same place, her attitude remaining the 
same ; her head inclined to the left side of the chest, the arms crossed, rest- 
ing upon the knees, and her eyes turned fixedly towards the sun. She remains 
thus, without moving, or uttering a word during the whole day. At meal 
time, she does not go for her food, but it is necessary to bring it to her, and 
press her to partake of it. She never changes her position to do this, and 
uses only the arm and hand of the right side. If any one approaches the pa- 
tient, or speaks to her ; if they interrogate or exhort her ; her countenance be- 
comes slightly flushed, and sometimes she turns her eyes aside, but never 
speaks. It is necessary to inform her when it is time to retire ; when she un- 
dresses, gathers herself up in bed, and envelopes her person entirely in the 
coverings. Menstruation is irregular and scanty ; and is suppressed for six 
months. We never succeeded in overcoming the silence of this female, nor 
her aversion to motion. She never had an attack of fury, and died of phthisis 
at the age of twenty-nine years. 

The following presents to us lypemania with different characters from those 
Avhich we observed in the preceding case. In the latter, the lypemaniac seems 
to be overcome by the weight of the emotions that oppress her, whilst in the 
following case, the patient reveals by her look and attitude, the activity and 
fixedness of her mind and affections. Mad'lle W., tall, and of a remarkably 
strong constitution, had spent her infancy in the chateau of Chantilly, and 
had often sported with the duke d'Enghien, himself a child. At the period of 
the emigration, she was committed to a lady, who was charged to watch over 
her education. Political events became more serious. She experienced mis- 
fortunes, and her education was neoflected. At the death of the duke d'Eng- 
hien, she falls into the most profound lypemania, and though only sixteen or 
seventeen years of age, her hair becomes almost immediately gray. She was 
sent to the Salpetriere, where she survived many years. She was very tall and 
slender, her hair very abundant and gray, and her large blue eyes, motionless. 
She was pale, and clad simply in her chemise, with uncovered head ; sat 
constantly upon the bolster of her bed, the thighs flexed upon the abdomen, 
and the legs upon the thighs. The elbows rested upon the knees, and the 
head, always elevated and turned to the right, was sustained by the right hand. 
During the night, the position of the patient is the same, but she sits upon 
the mattress, supporting her back against the bolster, and collecting the cover- 
ings about her chest. She never speaks, but from time to time murmurs in 
a very lov/ tone, a few monosyllables, which lead us to believe that she sees 
and regards some one. She responds to no question, but repulses by a move- 
ment of the body, the person who interrogates her. She eats little, and con- 
stipation is obstinate. She moves about upon the nates, after the manner of 
cripples ; raising her body by the aid of her hands. Her eyes and attention 
are never turned from a window which is near her bed, and through which, 
she seems to see or hear some one, who fixes her attention. The thighs and 
legs, by their long continued fixed condition, are contracted, and some at- 
tempts that have been made to extend them, have proved ineffectual. 

Oneness of affection and thought, renders the actions of the melancholic 



(5 



LYPE MANIA OR MELANCHOLY. 205 

■uniform and slow. He refuses indeed, all motion, and passes his days in so- 
litude and idleness. He habitually sits with his hands crossed, or stands in- 
active, with them hanging by his side. If he walks, it is slowly, and with 
apprehension, as if he had some danger to shun ; or with haste, and always 
in the same direction, as if his mind was profoundly occupied. Some, lace- 
rate their hands and the ends of the fingers, and destroy the nails. Torment- 
ed with grici or tear, the eye and ear are incessantly on the watch. For the 
lypemaniac, day is without repose, and the night without sleep. The secre- 
tions are no longer performed. Some melancholies obstinately refuse all nou- 
rishment. We have seen them pass several days without food, although hun- 
gry ; being restrained by hallucinations or illusions, which give birth to chi- 
merical fears. One, fears poison, another, dishonor ; the latter wishes to do 
penance, the former believes that if he eats, he shall compromise his relatives 
or friends ; in fine, there are those, who hope to rid themselves of life and its 
torments, by abstinence from all nourishment. We have seen some of them 
sustain an abstinence of thirteen, twenty and more days' continuance. When 
we triumph over the repugnance of these patients to taking food, the greater 
part of them are less gloomy and sad. See Suicide. The pulse is ordinarily 
slow, feeble, and concentrated ; sometimes it is very hard, and we feel under 
the fingers a sort of trembling of the artery. The skin is arid, and attended 
with a dry and burning heat. Transpiration has ceased, while the extremities 
of the limbs are bathed in sweat. 

Lypemaniacs sleep little ; inquietude and fear, terror, jealousy and halluci- 
nations, keep them awake. If they grow drowsy, no sooner do their eyes 
close, than they see a thousand pliantoms which terrify them. If they sleep, 
their rest is interrupted, and agitated by dreams of an inauspicious character. 
They are often aroused from sleep by the nightmare, or dreams which repre- 
sent to them the objects which have caused, or continue their delirium. Some, 
after a favorable night, are more sad and uneasy. Others, think that they 
shall never reach the close of the day, and are better when night begins, per- 
suaded that they cannot then be apprehended. Others still, think that their 
uneasiness augments at the approach of night. They dread obscurity, soli- 
tude, insomnia, the terrors of sleep, etc. The secretions also, present re- 
markable disorders among lypemaniacs. In some cases, the urine is abun- 
dant, clear, and limpid ; in others, scanty, thick and turbid. There are me- 
lancholies who, from various motives, retain their urine for many days in suc- 
cession. We know the history of one patient, who was unwilling to urinate, 
through fear of inundating the world ; and who decided to do so, only after 
he had been persuaded that it was by this means alone, that a great conflagra- 
tion, which had just broken out, could be extinguished, 

Melancholy with delirium, or lypemania, presents in its symptoms when 
taken together, two striking differences. Those suffering from this calamity, 
now exhibit a remarkable susceptibility, attended with extreme mobility. 
Every thing produces a strong impression ; the slightest cause produces the 
most painful effects. Events, the most simple and common, appear to them 
to be new and singular phenomena, prepared expressly to torment and injure 
them. Cold, heat, rain and wind, cause them to shudder with pain and fear. 
Noise impresses them painfully, and strikes them with terror. Silence causes 
them to start, and frightens them. If any thing displeases them, they repulse 
it with rudeness and obstinacy. If their food is not agreeable to them, their 
repugnance to it is so great, as to produce nausea and vomiting. Have they 
any ground for fear, they are terrified ; have they any regrets, they are in de- 
spair ; do they experience any reverses, they believe that all is lost. Every thing 
is forced and exaggerated in their mode of feeling, thinking and acting. This 
excessive susceptibility causes them to be constantly meeting, in external ob- 
ects, with new causes of pain. Both day and night their ear is open for hear- 



206 LYPEMANIA OR MELANCHOLY. 

ing and their eye for seeing. They are constantly in motion, in search of 
their enemies, and the causes of their sufferings. They relate without ceasing, 
and to every one, the story of their ills, their fears, and despair. Again, the 
sensibility concentrated upon a single object, seems to have abandoned all the 
organs ; the body is indifferent to every impression, while the mind no longer 
engages itself, except upon a single object, which absorbs all the attention, 
and suspends the exercise of all the intellectual functions. The immobility 
of the body, and the fixedness of the features, together with an obstinate si- 
lence, betray the painful conflict between the understanding and affections. 
It is no longer a pain that agitates the mind, that causes complaints, cries and 
tears ; but an emotion which rather produces silence, shuts the fountain of tears, 
and is incapable of suffering. In this state of painful exaltation of the sensi- 
bility, not only are lypemaniacs inaccessible to every impression foreign to the 
object of their delusion, but they are also beyond the influence of reason, be- 
cause they but imperfectly perceive impressions. An abyss, say they, separates 
them from the external world. I hear, I see, I feel, say many lypemaniacs, but 
I am not as I formerly icas. Objects do not come to me, do not idrntify them- 
selves with my being ; a thick cloud, a veil, changes the hie and aspect of bodies. 
The most polished substances appear to me to be bristling loith asperities. 
External objects, no longer sustaining their natural relations, grieve, astonish, 
and frio-hten them. They have illusions of the senses, and hallucinations. 
They associate ideas the most strange and unlike; from all which spring con- 
victions more or less opposed to common sense, unjust prejudices, fear, fright, 
dread, awe and terror. 

The passions modify the ideas belief and determinations of the most ra- 
tional man. The depressing passions produce also a partial lesion of the un- 
derstanding. The intellectual life of him whom a melancholic delirium con- 
trols, is altogether imbued with the character of his passion. The mountain- 
eer cannot support a lengthened absence from the place of his nativity, ceases 
not to mourn, and at length pines away and dies, if he does not revisit the 
paternal roof He who fears the police, or the pursuits of the tribunals, is 
filled with alarm and dread, and is in constant apprehension of an arrest. He 
sees every where agents of police, and servants of the magistracy, and that too, 
among his friends and relatives. 

Antiochus dies, in despair of obtaining from Seleucus his father, the wo- 
man whom he adores. Ovid and Tasso, pass days and nights, in incessant 
agitation both of mind and heart, in consequence of the absence of the objects 
of their love. Fear, with all its shadows, whether the cause of it be real or 
imaorinary, exercises the most general influence over melancholies. One M'ho 
is superstitious, dreading the wrath of heaven, and the vengeance of the gods, 
is pursued by furies, thinks himself in the power of the devil, devoured by the 
flames of hell, and doomed to eternal punishment. Another, frightened by 
the injustice of governments, apprehends falling into the hands of the officers 
of the State, and of being conducted to the scaffold. He accuses himself of 
havino- committed the greatest crimes, for which he seeks to justify himself. 
He now prefers death to the agony of uncertainty, whilst at other times, he 
supplicates a delay in the execution of the punishment, from which nothing, 
in his opinion, can protect him. The latter, fears the treachery of men, and 
thinks that his secret enemies, the envious and wicked, tlireaten his fortune, 
his honor, his affections, and even life itself The slightest noise or move- 
ment, the most insignificant sign, or trifling expression, cause him to start with 
fear, and persuade him that he is going to die by the machinations of his ene- 
mies. If a more substantial and liberal education sets a man above these su- 
perstitious terrors, or fears of a similar import ; ingenious in self-torment, he 
finds the elements of grief and terror in his instructions and knowledge ; and 
his disquietudes originate in matters pertaining to science. This lypemaniac 



LYPEMANIA OR MELANCHOLY. 207 

thinks that he is subjected to the deadly influence of electricity or magnetism, 
and persuades himself that by means of chemical agents he may be poisoned ; 
or by certain occult instruments, physical science is preparing for him a thou- 
sand ills, hears whatever he utters, however great the distance, or even divines 
his thoughts. The remorse which sometimes succeeds to crimes of o-reat 
magnitude, throws the guilty into a state of melancholy and characterizes 
their delirium. Orestes is pursued by furies. Pausanias the Lacedemonian, 
having slain a young female slave that had been presented to him, is tormented 
even to the day of his death, by a spirit which pursues him wherever he goes, 
and which resembles his victim. Theodoric, having caused the decapitation of 
Symmacus, believes that he sees the head of his victim in that of a fish which 
is served upon his table. The too noted Santerre, expects every instant to be 
seized by soldiers, who are to conduct him to punishment. Lypemaniacs 
frighten themselves, from motives the most strange and imaginary. Alexander 
de Tralles says, that he once saw a woman who dared not bend her thumb, 
lest the world should come to an end. Montanus speaks of a man, who ima- 
gined that the earth was covered with a shell of glass, under which were ser- 
pents, and he dared not walk, through fear of breaking the glass, and being 
devoured by them. 

A general whom I had in charge, dared not go into the street, believing 
that all the passers-by, addressed him in terms of abuse or reproach. 

Some lypemaniacs are constantly laboring under fear, and consume their 
lives, in constantly recurring solicitudes ; whilst others are terrified by a vague 
sentiment, without any motive. I fear, say these patients, I fear ; but where- 
fore? I know not, i/et I fear. Their external appearance, their physiogno- 
my, their actions and discourse, all indicate fear the most profound and poig- 
nant, from which they can neither relieve themselves, nor secure the ascen- 
dency. The delirium takes the character of the moral affection which en- 
gaged the mind of the patient before the outbreak of the disease, or preserves 
that of the cause that produced it ; a fact which is especially noticeable when 
this cause acts promptly, and with great energy. A woman, in the course of 
a dispute is called a thief; she immediately persuades herself that every one 
accuses her of the same thing, and that all the agents of justice are in pursuit 
of her, to hand her over to the tribunals. A lady is frightened by robbers, 
who break into her house ; from this time she never ceases to exclaim, the 
robber ! Every man she sees, not excepting her own son, are brigands who 
are come to rob and assassinate her. On the slightest noise, she cries out, the 
robber ! thinking that they are breaking open the door of her house. A mer- 
chant meets with some small losses. He immediately thinks himself ruined, 
reduced to the most complete indigence, and refuses to eat, because he has 
not wherewith to pay for his food. A statement of his affairs is presented 
him, which shows that he is in very prosperous circumstances. He examines, 
discusses it, and seems to be convinced of his error ; but on the whole, con- 
cludes that he is ruined. Two brothers have a discussion respecting certain 
pecuniary affairs ; when the one persuades himself that the other wishes to 
kill him, in order to enjoy his property. A soldier loses his grade, and be- 
comes sad and thoughtful. He immediately considers himself disgraced, and 
persuades himself that his companions have impeached him ; and is perpetu- 
ally occupied in justifying his conduct, which has always been highly honora- 
ble. A woman sees her child thrown from a horse ; after which no reasoning, 
and not even the sight of the child, who is well, can convince her that he is 
living. 

In thus analysing all the ideas that torment lypemaniacs, we can readily 
refer them to some sad and debilitating passion. Could we not establish a 
good classification of lypemania, by taking as a basis, the different passions 
that modify and subjugate the understanding 1 Sometimes the moral senti- 



208 LYPEMANIA OR MELANCHOLY. 

ments of lypemaniacs not only preserve all their energy, but are exalted to 
the highest degree, although the patients themselves are lamenting the want 
of them, and are suffering from the profoundest sorrow. The principles of 
filial piety, love, friendship and gratitude, are sometimes carried to excess, 
and augment the disquietude and fears of the melancholic, and impel him to 
such acts as ilow from despair. Thus a mother believes she is abandoned by 
her husband, and desires to slay her children to preserve them from a like 
misfortune. A vine-dresser slays his children, in order to send them to heaven. 
The languor, and monotonous repetition of the movements, actions and words 
of the lypemauiac, and the state of despondency into which he is plunged, 
would impose upon us, if we believed that his mind was inactive, like his 
body. The attention of the melancholic is of very great activity, and direct- 
ed to a particular object with a degree of intenseness, that is almost insur- 
mountable. Wholly engrossed by the object that affects him, the patient can- 
not turn aside his attention, nor fix it upon other objects foreign to his affec- 
tion. The mind, like the brain is, if I may be allowed the expression, in a 
tetanic state, and a strong physical or moral commotion can alone cause this 
spasm to cease. There being no lesion of the reason, except on a single 
point, it seems as if lypemaniacs called into vigorous exercise all their intel- 
lectual power, to fortify themselves in their delirium. It is scarcely possible 
to imao-ine the full force and subtilty of their reasonings in sustaining their 
prejudices, disquietudes and fears. Rarely do we succeed in convincing, and 
never in persuading them. 1 understand tvell tchat you say to me, (says a 
melancholic), you spcnh reasonably , hut I cannot believe you. Sometimes, on 
the contrary, the mind of melancholies is in a cataleptic state. They seize 
upon with energy, and preserve with more or less tenacity, the suggestions 
that are made to them, and we can in such cases, cause them to change their 
notions almost willingly, provided that the new ideas have some relation with 
the prevailing passion. A lady gets the idea that her husband wishes to shoot 
her, escapes from her chateau, and throws herself into a well. She was told, 
that if she wished to destroy herself, poison would be an easier means of 
effectinor this purpose. She immediately becomes afraid of it, and refuses 
every kind of food. A melancholic conceives that he is disgraced. After 
havincr in vain sought to reassure him, they offer him religious consolation, 
when he at once believes that he is damned. 

Some lypemaniacs possess a knowledge of their condition, have a conscious- 
ness of its falsity, and of the absurdity of the fears with which they are tor- 
mented. They perceive clearly that they are irrational, and often confess it, 
with grief and even despair. They are however, brought back by the pas- 
sion that controls them, to the same ideas, fears, disquietudes and delirium. 
It is impossible for them to think, will or act against it. Many assure us, that 
a resistless power has taken from them their reason, and that this power is God, 
the devil, fate ; and that they no more possess the ability to direct it, than that 
of controlling their will. Is not this rf«somn§" lypemania ? The will of most 
lypemaniacs is inflexible. Nothing can subdue it, neither reasoning, nor the 
solicitations of the most active tenderness, nor threats. Nothing can triumph 
over their errors, their alarms or fears. Nothing can remove their prejudices, 
their repugnances or aversions. Nothing can divert them from the engrossing 
thoucrhts that occupy their mind and heart, but strong and unexpected shocks, 
sufficient to attract their attention. Some lypemaniacs no longer possess the 
power of volition, or if they will, they are wholly incapable of executing their 
purposes. After having struggled and combated a desire which presses them, 
they remain inactive. 

An aged magistrate, very much distinguished for his wisdom and eloquence, 
in consequence of troubles, is seized with an attack of monomania, attended 
with ao-itation, and even violence. After some months the delirium ceases, 



LYPEMANIA OR MELANCHOLY. 209 

but the patient retains unfounded prejudices. At length, he recovers the en- 
tire use of his reason, but remains unwilling to return to society, although he 
knows that he is in the wrong. He is also unwilling to occupy himself, or to 
think about his affairs, although he knows very well, that they are suffering 
from his caprice. His conversation is both rational and intellectual. Does 
one speak to him of traveling or of attending to his affairs, he replies ; / hioio 
that I ought and am able to do it, your advice is very good, I would follow 
yoxir counsels, I am convinced ; hut make me able to will, by means of this tvill, 
which determines and executes. It is certain, said he to me one day, that I 
only have the ability not to will, for 1 have my reason entirely, 1 know what I 
ought to do, but strength abandons me, when the time for action comes. 

Lypemaniacs are never unreasonable, not even in that sphere of thought 
which characterizes their delirium. They proceed upon a falpe idea, as well 
as wrong principles ; but all their reasonings and deductions are conformable 
to the severest logic. To one who is a stranger to their delirium, they differ 
in nothing from others ; — correctly appreciating whatever is brought under 
their observation, — judging well of persons and facts, and reasoning as justly 
as before their illness. But the character and affections, the habits and mode 
of life of the melancholic, have changed, as always happens in delirium, be- 
cause delirium changes the natural relations between the patient and the exter- 
nal world. He who was prodigal, is now avaricious ; — the warrior is timid and 
even pusillanimous ; — the laborious man no longer wishes to labor ; — liber- 
tines with grief reproach themselves, and repent ; — he who was the least ex- 
acting, cries out treachery ; — all are diffident and suspicious, and on their 
guard with respect to whatever they say or do. They speak little, uttering 
only a few monosyllables ; having but a single thought, they repeat incessant- 
ly the same words. A few only are loquacious, who utter complaints and re- 
criminations, expressions of fear and despair. 



CAUSES OF LYPEMANIA. 

The causes of melancholy are numerous, and are common to other forms 
of insanity. We shall speak in this place of those only, which have a more 
immediate influence on the frequency and character of melancholy. 

Seasons and climates. — Climates and seasons have a special influence on 
the production of this malady. The inhabitants of mountainous regions, who 
are partially civilized, are seized with nostalgia on leaving their country ; 
whilst the inhabitants of the plains who are advanced in civilization, are little 
disposed to suffer from this malady. The neighborhood of marshes, or a fog- 
gy and humid atmosphere, by relaxingt he solids, predisposes to lypemania. 
Dry and warm countries, where certain winds prevail, also predispose to it. 
All know the effects of the sirocco upon the Italians, in producing melancho- 
ly ; of the solano, upon the Spanish, and the kamsim upon the Egyptians. 
In regions where the atmosphere is hot and dry, sensibility is most exalted, 
the passions are most vehement, and melancholies most numerous. Such 
were Greece and Egypt, according to the testimony of Areteus, of Bontius, 
Prosper Alpin and Avicenna. This report is confirmed by the statement of 
modern travelers, who assure us that melancholic affections are frequent in 
Asia Minor, in Upper Egypt, Bengal, and on the African coasts. Hippocra- 
tes, and all authors who have succeeded him, assure us that autumn is the 
season which produces the greatest number of melancholies. This season, 
according to Cabanis, is fruitful in maladies of this kind, in proportion as the 
summer has been hot and dry. This remark is confirmed by my own obser- 
vations, made in the autumn of 1818. AH physicians noticed that melancho- 

27 



210 



LYPE MANIA OR MELANCHOLY. 



ly was more frequent this year, during the months of October and November, 
than in preceding years. We received at the Salpetriere, during these two 
months, a much greater number of melancholies, and particularly of suicides, 
than we usually admitted. Notwithstanding the general opinion, I shall be 
compelled to believe that spring and sunnner produce, at least in our tempe- 
rate regions, more melancholies than other seasons. This difference may 
perhaps depend upon difference of climate. It is certain that the reports, 
made during four years at the Salpetriere, justify this opinion, which will ap- 
pear perhaps a paradox, but which I think worthy the attention of observers, 
especially as it is confirmed by my later observations. It is with this hope, 
that I hazard my doubts without farther discussion. 

Finally, the most favorable season for the cure of lypemaniacs, is spring; 
whilst lypemania is ordinarily exasperated during autumn and winter. 

TABLE OF LYPEMANIACS WITH RESPECT TO SEASONS. 



Report of the Salpetriere. 


Months. 
January 


1811 


1812 


1813 


1814 


Totals. 


3 


3 


9 


5 


20 


February 


5 


3 


7 


4 


19 


March 


10 


5 


9 


5 


29 


April 


4 


9 


4 


4 


21 


May 


11 


19 


12 


4 


46 


June 


1 


11 


10 


6 


34 


July 


9 


1(3 


12 


8 


45 


August 


. B 


10 


11 


15 


44 


September 


14 


4 


12 


9 


39 


October 


G 


8 


IG 


5 


35 


November 


8 


8 


6 


4 


26 


December 


12 


5 


10 


7 


34 



According to the preceding table, it is certain that during four years, the 
admission of lypemaniacs has been more numerous at the Salpetriere, during 
the months of May, June, July and August, than the other months of the 
year. 

Age. — The mobility of infancy, as it secures the child from strong and du- 
rable impressions, would entirely protect it from lypemania, were it exempt 
from all passion. But jealousy sometimes poisons the sweet enjoyments of 
early life, and produces a true melancholy with delirium. Some children, 
jealous of the tenderness and caresses of their mother, become pale and ema- 
ciated, fall into a state of marasmus, and die. Children are also exposed, 
though less frequently, to nostalgia. At the epoch of puberty, the develop- 
ment of new organs exciting new wants and sentiments, the young adolescent 
feels the influence of new passions, and his days pass happily and peacefully 
away, without regrets for the past, or solicitudes respecting the future. But 
if the primitive passions exercise over him complete sway, and exalt his imagi- 
nation ; vexations, the torments of love, and erotomania, come in to mar his 
earliest enjoyments. The struggle of the amorous passions with religious 
principles, vi'hich are the fruit of early education, exposes the young man to 
religious lypemania; and if onanism, or premature enjoyments; if the abuse 
of pleasure and excessive study, have been substituted for the pure and varied 
pleasures of this age, we ought then to fear an incurable melancholy. At 



LYPEMANIA OR MELANCHOLY. 



211 



adult age, the sensibility is less excitable, the imagination less active, and the 
other faculties of the mind act with greater energy. Factitious passions re- 
place the passion of love ; relations with loved objects become relaxed, whilst 
family cares, personal interest, love of glory and ambition, assume a more 
complete empire over the soul.. If troublesome predispositions exist, and if 
moderation places no check upon the factitious or social passions, at the least 
shock or reverse, man becomes gloomy, sad, suspicious, and in fine, melancho- 
lic. It is also, towards the termination of this period, that the disturbances 
connected with the cessation of the menses, and the abandonment of the world 
and its pleasures, expose women to a thousand varied ills, and among them, to 
melancholy ; particularly those, who have made society and coquetry, the only 
occupation of their frivolous life. A sense of his weakness, renders the old 
man more composed. His thoughts and desires have lost their energy, the 
imagination is at rest, the passions are extinct; and can melancholy take pos- 
session of minds destitute of passion? This malady is very uncommon in old 
age, except that form which is denominated senile melancholy ; a state, in 
which the old man, after a stormy and dissipated life, meditating upon the 
errors into which his passions have drawn him, isolates himself, becomes sad, 
uneasy, hard to please, avaricious, suspicious and egotistical ; often unjust 
towards his friends, his own children and society at large. 

The following abstract, made at the Salpetriere, proves that lypemania is 
very frequent in early life, that is to say, between the age of twenty-five and 
thirty-five years; and that it constantly diminishes after this period, and rarely 
appears after the age of fifty-five years. The report, made up from the higher 
and wealthy classes of society, gives the same results. ^ 



TABLE OF AGES. 











Ages. 












Years. 


20 


25 


30 


35 


40 


45 


50 


55 


60 


1811 


7 


19 


16 


13 


13 


10 


9 


1 


6 


1812 


8 


23 


16 


9 


15 


9 


12 


3 


6 


1813 


8 


14 


18 


15 


17 




11 


3 


9 


1814 


4 


8 


12 


10 


7 




6 


4 


8 


Totals. 


27 


64 


62 


47 


52 


48 


38 


11 


29 



Sex. — Women, in consequence of their constitutional gentleness, and the 
mobility of their sensations and desires, as well as by the little application which 
they make with reference to any matter, seem to \)& less subject than men, to 
melancholy. Such was the opinion of Areteus, of Coelius Aurelianus and 
the ancients. But, are not the extreme susceptibility and sedentary life of 
our women, their peculiarities even, the predisposing causes of this malady ? 
Are not women under the control of influences to which men are strangers ; 
such as menstruation, pregnancy, confinement and nursing? The amorous 
passions, which among them are so active ; religion, which is a veritable pas- 
sion with many, when love does not exclusively occupy their heart and mind, 
jealousy, fear, do not these act more energetically upon the minds of women 
than men ? Religious melancholy is also very frequent among them, especially 
in the lower classes of society, and in countries where ignorance generally 
prevails. Girls, widows, and sometimes women at the critical period of life, 
are a prey to erotic melancholy. Men, says Zimmermann, are insane from 
pride, girls from love, and women from jealousy. 



212 LTPKMANIA OR MELANCHOLY. 

Temperaments. — The melancholic temperament of the ancients, and the 
bilious-nervous of Halle, predispose to lypemania. Persons of this tempera- 
ment are tall and slender, and the muscles small, but well defined. The chest 
is narrow and confined, the skin brown or sallow, the hair black, and the eyes 
are sunken and full of fire. The physiognomy is sad and uneasy, the look 
timid or fixed, sensibility is exquisite, and all the passions are extreme. These 
individuals love or hate intensely, and with obstinacy. Thoughtful, taciturn, 
jealous and suspicious, they concentrate their affections. Society calls upon 
them importunately, but they fly from it ; preferring solitude, in which their ima- 
ffination and affection can exercise themselves without disturbance. They are 
well calculated for the cultivation of the arts and sciences. They have little 
memory, but their ideas are strong, their conceptions vast. They are capable 
of profound meditation. Often, exclusively devoted to the objects of their study, 
it seems as if they had no thought or interest, except in a single definite ob- 
ject, to which they devote themselves with the utmost ardor. These persons 
are especially predisposed to lypemania. It was said by Aristotle, that men 
of genius, and great statesmen, are ordinarily melancholies. Mahomet, Lu- 
ther, Tasso, Cato, Pascal, Chatterton, J. J. Rousseau, Gilbert, Alfieri, Zim- 
mermann, etc., confirm the opinion of Aristotle, which was justified by his 
own individual example. This temperament does not belong exclusively to 
that variety of genius, which engages itself in thinking, speaking, and doing 
well; but is the temperament also, of some great villains, and very wicked 
persons. Those evil geniuses, who are sent into the world to be the terror of 
it, and to tyrannize over their fellow citizens, are not always exempt from the 
torments of the blackest melancholy. Their harsh and repulsive physiognomy 
wears the impress of their hateful and malevolent passions. Their aversion 
to men, causes them to seek solitude, and to fly the presence of their fellow 
creatures. Acquired constitutions of temperaments, in which the hepatic or 
hemorrhoidal system predominates, also predispose to lypemania. 

Professions and mode of life. — Corporeal labor maintains the physical forces, 
at the same time that it distributes them uniformly among all the organs. It 
is the best check upon the passions, which it moderates, at the same time that 
it prevents the imagination from blending itself with our pleasures and cor- 
rupting them. An idle and inactive life, the transition from a very active to a 
slucrwish and indolent one, abounding in leisure ; excessive nicrht-watchinor, by 
exhausting the physical energies, and sleep unduly prolonged, by depressing 
the powers both of body and mind; occasion moroseness and mental torpor. 
Excessive study exhausts man, says Celsus, more than labor of the body, if it 
encroaches upon time, which properly belongs to repose and exercise. If it 
is concentrated upon a single object, and this is abstract, mystical or romantic, 
then the man is in constant danger of becoming a lypemaniac. Melancholy 
is still more to be dreaded, if, to excessive study, are joined errors of regimen, 
dissipated and dissolute conduct, or a too decided taste for a solitary life. 
Zimmermann relates many examples of melancholy, produced from this last 
cause.* There are certain professions, which more particularly predispose to 
this malady, because they exalt the imagination and passions, and expose those 
who practice them, to errors of regimen of every kind : such are musicians, 
poets, actors, and merchants who are engaged in hazardous speculations. I 
could name more than twenty actors, in behalf of whom I have been con- 
sulted. 

The physical causes, which we may call pathological, in general act by en- 
feebling the constitution, or by impressing upon the fluids, a morbid character. 
Prolonged fasting and hunger, have been referred to by several authors, par- 

" SJohtude, trans, by A. J. L. Jouidan, Paris, 1825, in 8vo. 



LYPEMANIA OR MELANCHOLY. 213 

ticularly Santacnix, as calculated to produce melancholy. This influence is 
even consecrated in popular language, and the habit of surcharging the sto- 
mach with aliment, difficult of digestion, especially among men who take little 
exercise, disposes to the same malady. Some physicians have pretended, that 
the habitual use of milk renders one sad, and is hurtful to melancholies. It 
is certain that the use of this article produces head-aches among persons of a 
bilious-nervous temperament. The abuse of opium, of hot drinks, and alco- 
holic liquors, often causes lypemania, and leads melancholies to suicide. Per- 
haps we ought to attribute to the abuse of hot drinks and alcohol, the great 
number of suicides which we observe in England. This is indeed the opinion 
of many English physicians. Women are often brought to our hospital who, 
while in a state of intoxication, or during the delirium that succeeds it, fall 
into a state of lypemania, with an inclination even to suicide. Onanism and 
continence after marriage, sometimes produce melancholy. The suppression 
of an habitual evacuation, of the transpiration, of a hemorrhoidal flux, and 
obstinate constipation, occasion melancholy. Sanctorius has observed, that a 
defect of transpiration renders a person sad, and Voltaire remarked, that con- 
stipation influenced to a frightful extent, the determinations of the oreat. 
The retrocession, or sudden cessation of any morbid affection whatever, may 
cause lypemania where there is a predisposition to the malady. The same 
effect may be produced, by the suppression of an issue, herpes or psora. We 
see lypemania replace phthisis pulmonalis, hysteria, hypochondria, epilepsy, 
mania and monomania, or alternate with these diseases. It is not rare that, 
on the cessation of the general delirium and excitement which characterize 
mania, those so afflicted fall into a state of profound melancholy, with an indi- 
cation even to suicide. Some are controlled by a painful sentiment, with which 
the recollection of their delirium inspires them, a sentiment unfortunately 
strengthened by prejudice. Others are impressed with the idea that they are 
no longer of any service in society, and persuade themselves that they are use- 
less, or a charge to their relatives and friends, or objects of contempt among 
their fellow citizens. 

M. W., forty-eight years of age, and of a very strong constitution, having 
taken an active part during the reign of terror, is removed by the directory, 
and sent on an embassy. The first Consul recalls him and names him a pre- 
fect. Not being appointed to a post corresponding with that which he had just 
left, nor by any means with the aspirations of his ambition, he gave himself 
up to a thousand exaggerations and extravagances, in his conversation and 
actions. He soon persuades himself that he is king, and abandons himself to 
all the pretensions with which such a conviction inspires him. He requires 
that every one should prostrate himself before him, is constantly making and 
unmaking ministers, and prodigal of favors, honors and wealth. His step is 
proud and imposing. He sleeps little, eats much, and suffers from constipa- 
tion. He is committed to my care, and after some months recovers his rea- 
son, takes a very correct view of his condition, and we consider him cured. 
Soon after however, he falls into a profound melancholy with delirium, accom- 
panied with sadness and imaginary fears, which follow him to the close of life. 
He dies, from a frightful cerebral hemorrhage, five months after the attack of 
melancholy. At the post-mortem examination, the cerebral substance was 
found to be very much injected, softened, and as it were, triturated, around 
the effused blood. All the viscera were healthy. The o-emini muscles re- 
sembled smoked bacon, having the color and density of it. Their normal 
texture, together with the muscular fibres, had disappeared. During the last 
two months of his life, he remained standing motionless, or walked, slowly 
placing the feet one before the other, at every step. From the commencement 
of this disease, he had manifested some slight symptoms of a paralysis of the 
tongue, and had acquired much flesh. 



214 LYPEMANIA OR MELANCHOLY. 

The passions constitute a true form of insanity, but one which is of tem- 
porary duration. They take possession of the intellectual faculties, and so 
completely absorb them, that the individual is incapable of directing his 
thoughts to any thing other than the object of his passion. Whether the mo- 
ral affections and the passions have their seat in the heart, in the phrenic cen- 
tre, in the solar plexus, in the trisplanchnic nerve, in the ganglions, in the 
brain, or are only the effects of a reaction of the soul or vital principle, it 
is ever true, that they exercise a powerful influence over the functions of or- 
ganic life, as well as the understanding. If the passions have an influence 
over all our functions in a state of health, how much more energetic will this 
influence be in a malady, in which disorder of the passions forms the principal 
characteristic ! The moral affections are the most frequent cause of lypema- 
nia ; their disorder is the most prominent symptom of it, and in the hands of 
a skillful physician, are a powerful means of cure. Disappointed affection, 
jealousy, fear, — which is the perception of a future ill, or one which threatens 
us, — and fright, — which is the perception of a present ill, — are the passions 
which produce the greatest number of lypemaniacs, particularly in youth, 
among women, and in the lower classes of society ; whilst ambition, avarice, 
wounded self-love, reverses of fortune, and gaming, are the most frequent 
cause of insanity among adults, and men of mature age, in the higher classes 
of society, and in those countries whose customs and institutions foster all 
the social passions. The depressing passions are, most generally, the cause 
of melancholy with delirium. At one time, they act slowly, and by repeated 
attacks, progressively fatigue the organs, and steel, so to speak, the sensibility. 
The enfeebled mind then supports with difticulty any opposition, and man be- 
comes fearful, because he is feeble, and very sensitive. At another, the mo- 
ral affections, lively and abrupt, suddenly overwhelm the sensibility, and at 
once sink the patient into melancholy. The following tables indicate the 
differences, with respect to frequency, which the causes of lypemania present. 

TABLE OF CAUSES. 

Hereditary predisposition . . , .110 

Suppression of the menses . . . , 25 

Critical period . . . . . .40 

Consequences of confinements ... 35 

Fall upon the head . . . . .10 

Masturbation ..... 6 

Libertinism . . . . . .30 

Abuse of wine ..... 19 

Domestic troubles . . . . .60 

Reverses of fortune and consequent misery . 48 

Disappointed affection . . . . .42 

Jealousy ...... 8 

Fright ....... 19 

Wounded self-love ..... 12 

Anger . . . . . . .18 



o 



Total ..... 482 

The causes of lypemania, like those of other mental diseases, do not always 
act immediately upon the brain ; that is to say, there are cases of sympathetic 
melancholy. Now, different foci of sensibility react upon the brain, to pro- 
duce the delirium of melancholy ; and now, the predominance and lesion of 
an organic apparatus, occasion the same reaction. All the symptoms appear 



LYPEMANIA OR MELANCHOLY. 215 

to depend upon the disorder of some viscus, more or less remote from the 
centre of sensibility. How numerous are the cases of melancholy, that have 
succeeded hypochondria ! How many melancholies are there, who recognize, 
in particular, lesions of the abdominal viscera, as the causes of chronic mala- 
dies ! Hence, we give to these affections the appellation of hypochondriacal 
lypemania. I have seen a merchant who, having fallen into a profound me- 
lancholy, attended with a refusal to take nourishment, and attempts upon his 
life, assured us, that a foreign body had been arrested in his throat, which 
entirely prevented his swallowing. His friends were certain that he had taken 
nothing that could cause an inflammation of the cesophagus, and an inspection 
of the part, removed all disquietude with respect to it. The patient, in the 
deepest distress, was constantly demanding the removal of this foreign body. 
Three months afterwards, he fell into a marasmus and died. 

At the post-mortem examinatioH, I found an ulcer of a syphilitic aspect, 
occupying the superior third of the cesophagus. Bonet speaks of a country- 
man, who assured him that he had a toad in his stomach, that he heard his 
noise, and felt him hopping about, etc. At his death, they found a cancer of 
that organ. I have many times seen hypochondriacal lypemaniacs, who affirm- 
ed that they had devils in their stomachs, and believed that the abdomen 
was full of unclean animals. They were also convinced that, by the aid of 
electricity and magnetism, the most acute pains were produced in their intes- 
tines. In these cases, the opening of the bodies revealed chronic peritonitis, 
a cancer of the stomach, and gangrene of the transverse colon. One patient 
thought he had birds in his belly, and was afraid to go to the water-closet, 
through fear that these birds escaping, we should become apprised of his in- 
firmity. Many times, he begged me to listen to the noise of these birds. 
What he experienced, resulted from flatus, and borborygmi. 

The causes of lypemania, like those of all other maladies, are predisposing 
or remote, proximate or exciting ; but these distinctions cannot be rigorously 
applied to this or that cause, for it often happens, that those causes which we 
call predisposing, are exciting ; and reciprocally. The exciting causes alone, 
seem to have been sufficient to provoke the malady. Usually however, there 
is a concurrence of the two orders of causes. A first event, disposes to the 
disease ; a second, causes it to break forth. 

M. B., twenty-three years of age, is on the eve of marriage to the lady whom 
he adores. Insurmountable obstacles interfere, to break up their designs. 
He becomes sad, morose, uneasy, flies society, and in a word, is melancholic. 
At the expiration of six months, he fails to obtain in the service, the advance- 
ment which he expects, and immediately falls into the deepest despair. He 
accuses all men of injustice, and believes himself to be the object of their 
hatred and persecutions. In the street, while walking, and in traveling, he 
often thought that they were mocking him, and demanded satisfaction of them. 
He once fought a duel with a soldier whom he had never before seen, Avith 
whom he met by accident, and by whom he persuaded himself that he had 
been insulted. At length, he made several attempts to commit suicide, but 
was cured after the lapse of a year. 

A merchant forty-five years of age, is interested in a bankruptcy, which for 
a brief period embarrasses him, without impairing his fortune. On the day 
of this reverse, his character changes. He becomes more gay than usual, and 
laughs at this mischance ; felicitating himself in having thereby acquired a 
more thorough knowledge of men. He forms projects incompatible with his 
fortune and unsuited to the condition of his affairs. Eight days pass in this 
state of joy, satisfaction and activity, which occasions apprehension of a grave 
disease, of which he has himself a presentiment. After this epoch, political 
events wholly foreign to his interests, but which oppose his views, plunge him 
into a melancholy delirium from which nothing relieves him. 



216 LTPEMANIA OR MELANCHOLY. 

It is not rare, to see lypemania burst forth without any assignable cause. 
Nevertheless, by observing the patient with special care, by informing our- 
selves of his mode of livino- and habits, we discover the true origin of the 
evil, which is often some concealed moral affection. Hippocrates, Erasistra- 
tus, Galen, and Ferrand in his Treatise on Love, cite memorable examples of 
their sagacity in discovering the feigned or concealed causes of lypemania. 
I have often been able to foretell that onanism was the real but concealed 
cause of the disease. It also happens, that the exciting causes, whether phy- 
sical or moral, act so suddenly, that the delirium appears at once, especially 
when the predisposing influences are numerous or strong; Lypemania is 
continued, remittent or intermittent. The remittent form is most frequent, 
and there are few lypemaniacs whose delirium is not exasperated on alternate 
days. Many experience a very marked remission at evening and after dinner ; 
whilst others suffer most on waking, and during the early part of the day. 
With the latter, this exasperation of the symptoms, depends, now upon the 
pain which they experience at the thought of being obliged to drag out a 
miserable existence for another day, whose interminable length frightens them, 
and now, from fear that their enemies will profit by the occasion, to execute 
their dreadful purposes. Certain persons, who suffer from panophobia, are 
afraid at the approach of night and darkness. The shades of night arouse 
their apprehensions ; robbers can more readily introduce themselves ; insom- 
nia and dreams terrify them in advance. Intermittent melancholy presents no- 
thing in particular ; nothing that we can add to what has been said respect- 
ing intermittent insanity. 

Continued lypemania has, in general, a very slow course ; and besides the 
partial delirium which characterizes it, is complicated with a multitude of 
symptoms, whose exasperation coincides with that of the delirium, or provokes 
it. It is usually in the spring that it terminates in health ; but can we rely 
upon an effectual cure, if it is not preceded by some commotion or by some 
crisis, either physical or moral ? I am always doubtful respecting a cure, 
when I have been unable to observe any previous crisis. As in other forms 
of insanity, so in this, crises are very numerous. Now, they occur by the 
skin, in the reestablishment of the transpiration, in abundant sweats, exanthe- 
mata and furuncles. We find examples of them in every author ; now, by 
habitual hemorrhages which were suppressed, and by the menses ; and now, 
by mucous, bilious, brown, blackish and even sanguineous evacuations, which 
take place, either by vomiting or alvine dejections. These critical evacua- 
tions are observed more frequently than others ; are referred to by all authors, 
and are the crises which art may provoke with the greatest success. Hippo- 
crates tells us that Adamentus was cured by vomiting a great quantity of 
black matter. Lorry and Halle* relate similar examples. Pinel speaks of 
the cure of two melancholies ; one, by the development of one of the paro- 
tids ; the other, by a jaundice. Lypemania is also terminated by moral shocks. 
A violent passion suddenly provoked, by producing a diversion of the thoughts, 
which have been previously fixed, effects a cure. The malady ceases from 
the effect of fright or fear, and by the effect of a stratagem well concerted, 
and managed according to the character of the malady and that of the pa- 
tient. The return to reason also takes place, when by his attentions and dis- 
courses, a skillful physician knows how to possess himself of the confidence of 
the patient. This first step taken, the cure is easy. In some cases, we effect 
a cure by satisfying the desires of the patient, and granting to him the ob- 
ject of the passion which has provoked the delirium. Melancholy is also ter- 
minated by the e.\plosion of maniacal delirium. This termination is rare ; 
and we might anticipate, that the transition from tranquil lypemania to fury, 

* Memoirs of the Medical Society of Emulation, t. iii, p. 348. 



CRITICAL TERMINATIONS OF INSANITY. 217 

would be succeeded by fatal accidents, and the prelude to a speedy death, 
either natural or provoked. Lypemania sometimes passes into mania. It is 
doubtless this transformation, which has caused melancholy to be confounded 
with m?.nia. It degenerates not unfrequently, into dementia. In this condi- 
tion, the prevailing ideas still remain ; but they are incoherent, without con- 
nection, order or harmony with the actions ; whilst before, the ideas and con- 
victions were strong, and the reasonings, desires and determinations, the just 
and immediate consequences of the ideas which characterized the delirium. 



DISEASES TO WHICH LYPEMANIACS SUCCUMB. 

POST-MORTEM EXAMINATIONS. 

Melancholy terminates in death. Lorry and Mead assure us, that phthisis 
pulmonalis is its most frequent termination. The English believe, that it 
often terminates in dropsy of the chest. The great number of post-mortem 
examinations that I have made, confirm the observation of the first named 
writers. I have also seen many abdominal affections put an end to the exist- 
ence of melancholies. Scurvy and consecutive gangrene, cause the death of 
a large number of lyperaaniacs. The want of exercise, and bad regimen of 
these patients, and the chagrin which pursues them, by enfeebling, exposes 
them to chronic inflammations of different organs. I ouo-ht not to forget ona- 
nism as calculated to produce the most fiital effects upon the health and life 
of these unfortunate people. It is one of those errors to which they yield 
themselves, and to which it is important to call the attention of those who 
have to direct and watch over the insane. 

Pathological anatomy has taught us nothing positive respecting the seat of 
melancholy. It is not that the examination of bodies is wanting, but observa- 
tions are incomplete. We cannot distinguish what is proper to lypemania, 
from vyhat appertains to hypochondria or mania, with which it has been con- 
founded. In the post-mortem examinations of the insane, and consequently 
in those of melancholies, they have too frequently neglected to notice the dis- 
eases that caused their death. I have taken great pains to ascertain these 
diseases. The following are my observations with respect to this subject. 

TABLE OF DISEASES TO WHICH LYPEMANIACS SUCCUMB. 

Adynamic fever . . . . .10 

Marasmus, and slow fever .... 24 

Phthisis pulmonalis, and chronic pleurisies . . 62 

Diseases of the heart .... 16 

Chronic phlegmasise of the abdomen . . .32 

Scurvy ...... 26 

Apoplexy ...... 6 

Total ...... 176 

From this report, it appears that melancholies die most frequently, in con- 
sequence of chronic diseases, particularly from affections of the chest. Ma- 
rasmus, and a slow nervous fever, present all the characteristics of the tahes 
melancolica described by Lorry. These patients complain, some of them of 
cardialgia, others of colics. They eat little, though in some cases the appe- 
tite is voracious. Nevertheless, they become gradually emaciated and enfee- 
bled. Constipation is at first obstinate, and they suffer from irregular febrile 
paroxysms, which occur most frequently at eveninor. The pulse is feeble and 

28 



218 CRITICAL TERMINATIONS OF INSANITY. 

concentrated, and the heat of the skin pungent. The skin is sometimes co- 
vered with a viscous perspiration, but is most generally dry, and of an earthy 
aspect. The patients fall into a state of extreme feebleness, and no longer 
leave their bed. They lose both voice and appetite ; their features change, 
and at length life becomes extinct, without a struggle or pain. Some lype- 
maniacs are for a longer or shorter period before death, troubled with a serous 
and sometimes a sanguineous diarrhoea, which is symptomatic of phthisis, 
scurvy and chronic enteritis. The ancients ascribed melancholy to accumu- 
lations of black and thick bile, and to corroding humors, which, arising to 
the brain, obscured as with a veil, the organ of thought, and thus impressed 
a sad, sombre and timid character upon the delirium of melancholies. Some 
authors have pretended to find these humors in the brain. The advancement 
which pathological anatomy has made in our days, permits us to offer a reason 
for this phenomenon. It is very true, that we find in the brain of some me- 
lancholies, a reddish, yellow fluid ; but every one now knows, that this is not 
bile, but the residue of a sanguine effusion, or of a softened portion of the 
brain. This matter is now contained in a cyst ; and now effused in a loose 
net-work, formed by the cerebral substance. This alteration we observe in 
the brain of individuals, who have never been insane. It coincides with me- 
lancholy, but is neither the cause nor effect of this malady. 

Bonet, in the Sepulchretum, says that the vessels of the encephalon are dis- 
tended and engorged with blood, and that there are effusions into the sinuses of 
the brain. He refers especially, to lesions of the thorax and abdomen among 
melancholies. Boerhaave says that the brain is hard, friable, and of a yel- 
lowish white, and that the vessels of this organ are gorged with coagulated 
black blood. We can conclude nothing from these facts, since the authors 
who report them, confound melancholy with mania. Some moderns assure 
us, that among melancholies the gall-bladder contains concretions, but this is 
by no means constant. The heart has sometimes appeared destitute of blood, 
or else its ventricles have been found full of concretions, called polypi. Gall 
assures us, that the cranium of suicides is thick and hard. I have in my 
possession, the crania of several insane persons who have committed suicide, 
which are very soft. One of the alterations which I have frequently met with 
amoncr melancholies, is the displacement of the transverse colon. I have re- 
ported several cases in proof of it. The transverse position of the colon be- 
comes oblique, and even perpendicular ; its extreme left is situated near the 
pubes, and is sometimes concealed behind the symphisis. The following case 
will interest those who are fond of political phenomena, and who seek for ex- 
traordinary facts in medicine, 

Teroenne or Theroigne de Mericour, was a celebrated courtesan, born in the 
city of Luxemburgh. She was of medium height, had chestnut colored hair, 
large blue eyes, a changeful physiognomy, and a sprightly, free, and even ele- 
gant carriage. This girl, in the opinion of some, of honorable birth, and in 
that of others, springing from the rank of courtesans, acted a truly deplorable 
part, during the first years of the revolution. She was then from twenty- 
eight to thirty years of age. She devoted herself to the various chiefs of the 
popular party, to whom she was of service in most of the riotous disturbances, 
and contributed, especially on the /Sth and Gth Oct. 1789, to corrupt the regi- 
ment of Flanders, by leading into its ranks, women of ill fame, and by distri- 
buting money among the soldiers. In 1790, she was sent into the city of Liege, 
to arouse the people. She there took a military rank. She made herself 
remarkable among this unbridled populace, which was sent to Versailles on 
the 5th and Gth of Oct., 1790. The Austrians arrested her in the month of 
January 1791. She was conducted to Vienna, and confined in a fortress. 
The Emperor Leopold saw her, conversed with her, and caused her to be set 
^t liberty in Dec. of the same year. She returns to Paris, and once more ap- 



CRITICAL TERMINATIONS OF INSANITY. 219 

pears upon the stage during the period of the revolution. She then made 
herself conspicuous upon the terraces of the Tuileries, and on the rostrum, 
haranguing the people with boldness, in order to bring them back to modera- 
tion, and the Constitution. This course cannot suit her long. The Jacobins 
shortly repair to Teroenne, and we immediately see her appear, a red bonnet 
upon her head, a sword by her side, and a pike in her hand, commandinor an 
army of women. She took an active part in the events of September, 1792. 
Although it may not be proved that she participated in the massacres, it is 
said, nevertheless, that she entered the court of the abbey, and with her sword 
cut off the head of an unfortunate man, whom they were conducting to the 
tribunal of this prison. We are assured that it was a former lover. 

When the Directory was established, and popular associations ceased, Te- 
roenne lost her reason. She was conducted to a house in the suburb St. 
Marceau. They found in the papers of St. Just, a letter from her, dated July 
26th, 1794, in which signs of a wandering intellect are shown. In Nov., 
1800, she was sent to the Salpetriere and on the following month was trans- 
ferred to the Petites-Maisons, where she remained seven years. When the 
Administration of hospitals caused the insane to be removed from the Petites- 
Maisons, Teroenne returned to the Salpetriere Sept. 1807. She was then 
about forty-seven years of age. At the time of her admission, she was very 
much agitated, reviling and threatening every body, speaking only of liberty, 
of committees of public safety, revolutionary committees ; and accusing all 
who approached her of being moderates and royalists. In 1808, a distinguish- 
ed personage, who had figured as chief of a party, visits the Salpetriere. 
Teroenne recognized him, and raised herself from the bed of straw upon 
which she was lying, and overwhelmed the visiter with abusive language ; 
accusing him of having abandoned the popular party, and of being a moderate, 
to whom a decree of the committee of public safety would soon do justice. In 
1810, she becomes more composed, and falls into a state of dementia, which 
enabled us to observe traces of her early prevailing ideas. Teroenne was un- 
willing to wear any clothing, even a chemise. Every day, both morning and 
evening, and many times a day, she waters her bed, or rather the straw of it, 
with several buckets of water, lies down, and covers herself with her sheet 
only, in summer, and with both sheet and coverlid, in winter. She amuses 
herself in walking with naked feet, in her cell flagged with stone, and inun- 
dated with water. Severe cold causes her to chano-e this regimen in no re- 
spect. Never have they succeeded in inducing her to sleep in a chemise, nor 
to employ a second covering. During the last three years of her life, she was 
provided with a very large morning gown, which however, she rarely put on. 
When it froze, and she had not water in abundance, she was accustomed to 
break the ice, and take the water which she obtained from it and wet her 
body, particularly her feet. 

Although in a small and gloomy cell, very damp and without furniture, she 
enjoys good health, and pretends to be occupied with very important matters. 
She smiles to persons who accost her, and sometimes replies hastily, / know 
you not, and conceals herself under her covering. It is rare that she replies 
correctly. She often says ; / do not know ; I have forgotten. If they insist, 
she becomes impatient, and talks to herself in a low voice. She articulates 
phrases, interspersed with the words, fortune, liberty, committee, revolution, 
rascal, warrant, decree, etc. She applies many of them to the moderates. 
She is angry and transported with passion, when opposed ; especially when 
they desire to prevent her from taking water. She once bit a companion with 
so much fury, as to take out a piece of flesh. The disposition of this woman 
had therefore outlived her understanding. She rarely leaves her cell, gene- 
rally remaining there in bed. If she goes out, it is in a state of nudity, or 
covered only with her chemise. She takes but few steps, most frequently prp- 






220 CRITICAL TERMINATIONS OF INSANITY. 

ceeding upon all fours, and extends herself upon the ground. With a fixed 
eye, she collects all the oftal she finds upon the pavement, and eats it. I have 
seen her devour straw, feathers, dried leaves, and morsels of meat lying in the 
dirt. She drinks cistern water, whilst they wash the courts, although it may 
be dirty, and charged with filthy matters ; preferring this drink to every other. 
I endeavored to induce her to write. She traced a few words, but was never 
able to complete a sentence. She never gave any indication of hysteria. 
Every sentiment of shame seems to be extinct, and she is habitually naked 
without blushing, in the presence of men. Wishing to obtain her portrait in 
181G, she willingly sat for it, but appeared to attach no importance to the work 
of the painter. Notwithstanding the regimen to which she subjected herself 
for ten years, the menses were perfectly natural. Her appetite was good, she 
was not sick, nor did she contract any disorder. Some days before entering 
the infirmary, an eruption appeared over the whole body. She washed how- 
ever, as usual with cold water, and lay upon her wet bed. The eruption dis- 
appeared, and from that period she remained in bed, eating nothing, but 
drinking water. 

May 1st, 1817. Teroenne enters the infirmary, in a state of extreme feeble- 
ness, refusing all nourishment, drinking water, remaining in bed, and often 
talking with herself, but in a very low tone. 15th. Emaciation, extreme 
paleness of the face, eyes glazed and fixed, some convulsive movements of the 
face, pulse very feeble, slight swelling of the hands, and oedema of the feet. 
At length, on the ninth of June, she dies, at the age of fifty-seven years, 
without seeming to be restored, for a moment, to the use of her reason. 

Autopsy at 10 o'clock, A. M. Dara-mater adherent to the cranium, which 
is thick posteriorly, and the median line much warped. The brain was very 
soft and discolored, and the membrane which invests the ventricles, thickened. 
The subjacent cerebral substance, for the thickness of a line, is of a vitreous 
aspect, and a greyish white. The plexus choroides was discolored, presenting 
small serous cysts. The internal carotid arteries which pass along the caver- 
nous sinuses, have acquired the diameter of a very large quill. The pituitary 
gland contains a brownish fluid. There is serum in the plurae, as well as in 
the pericardium. The heart is flaccid. The stomach is distended with a 
greenish fluid. The transverse colon is precipitated perpendicularly, behind 
the pubes. The liver is small, and greenish in color; its tissue very soft; and 
its proper tunic detached with the greatest ease. The gall bladder is distend- 
ed with black, thick and clotted bile. The spleen is soft and green, like the 
liver. The bladder is very much contracted, and its walls thickened. The 
envelope of the ovaries is thick, and even cartilaginous at several points. In 
the case of Teroenne, as in those which follow, the transverse colon had 
changed its direction, and descended behind the pubes. 

Jane, fifty-eight years of age, is admitted at the Salpetriere Oct. 5th, 1811, 
having always enjoyed good health. Her father became insane after having 
been trepanned, and one of her daughters had thrown herself into the river 
after her confinement. By occupation she was a seamstress, was married at 
the age of twenty-six years, and became the mother of eight children. At 
forty-five years of age, the menses ceased without accident. When fifty-four 
years of age her son enters the army. Sadness, tears, melancholy and deli- 
rium succeed this event. She is several times bled, and is cured. Fifty-eight 
years of age. Suddenly, and without cause, she has a new attack of delirium, 
attended with sadness and weeping. This happened May 19th, 1811. On 
the 2 1st, they brought, her to Charenton, from whence at the expiration of five 
months, she is sent to the Salpetriere. Fifty-eight and a half years of age. 
At the period of her admission into the hospital, Oct. 5th, 1811, she is extreme- 
ly emaciated, her physiognomy expressive of disquietude and trouble, and her 
skin dry and brown. She is always ready to go away. During the night she 



CRITICAL TERMINATIONS OF INSANITY. 221 

leaves her bed, with a view to take her departure. She is constantly repeat- 
ing ; my God, my God ! and demanding her children. She prays us to con- 
ceal them, goes and comes, and worries herself — supplicating and often weep- 
ing. She is forgetful, not knowing even how to find her bed. She eats little ; 
and her dejections are frequent, involuntary, and of a mucous character. 
Oct. 26th. Jane enters the infirmary, in consequence of her feebleness and 
bowel affection. Besides, there are the same moral disquietudes and agita- 
tion ; nor does the sight of her relatives bring composure. Insomnia. Jan. 
1812. The feebleness augments, the diarrhoea persists, and the patient can 
no lonorer leave her bed. Towards the end of the month, the tongue becomes 
black, the lips brownish, and the pulse very feeble and frequent. All the ady- 
namic symptoms are clearly marked. In February, eschars form on both tro- 
chanters and the coccyx, and death takes place on the 11th of the month. 

Autopsy, the 12th. Marasmus ; cranium soft and injected ; the median 
line dividing the brain into two unequal parts. Serum at the base of the cra- 
nium ; cerebellum soft, and cerebrum dense. The arachnoid is injected, and 
the plexus choroides presents small serous cysts. The lateral ventricles are 
reduced on every side, with very extended adhesions at the posterior part. 
The transverse colon has fallen almost perpendicularly into the pelvic cavity, 
carrying with it a great part of the descending portion. The stomach is con- 
tracted with deep folds, and its mucous membrane presents traces of inflam- 
mation. The intestines contain little else than a greenish mucus, with slight 
traces of inflammation. The gall-bladder is very much distended with a fluid, 
yellow bile, mingled with many small, yellow concretions. The spleen is 
small. The muscles are pale, and easily torn. 

Barbe, a Benedictine widow, a native of Martinique, and a negress, thirty- 
seven years of age, was admitted at the hospital July 14th, 1812, without our 
being able to obtain the least information respecting her previous condition, 
mode of life, or the causes and duration of her malady. At the period of her 
admission, Barbe is emaciated, her eyes are large, haggard, and sometimes 
threatening. On her arrival, she was placed in bed, was feeble, and her skin 
dry and hot. She drank much, but was unwilling to eat, assuring us that 
they wished to poison her. She appeared to tremble with fear, so soon as 
any one approached her. Her look at length became indirect and uneasy. 
She drove persons from her, threatened them, called them villains, rascals, 
and poisoners. She seemed to recognize in us the objects of her hatred, her 
fears and her fury. She constantly refused to take any thing but water, al- 
though she consented to drink a little weak wine with it. July 29th, 1812. 
Frequent cough, especially at evening, oppression and fever. Blisters to the 
legs. Aug. 8th. Spitting of blood ; pulse feeble, and a well marked parox- 
ysm : at evening cough. Barbe demands with temper, remedies Avhich she 
does not take. 12th. Prostration, and still greater oppression ; blisters do 
not discharge. 14th. Diarrhoea, limbs swollen. ICth. Saliva greenish, and 
very fetid, dyspnoea. 17th. Shivering fits, and disappearance of the swell- 
ing. 18th. Death took place at six o'clock in the morning. 

Autopsy on the morning of the 19th. She is tall, emaciated, and there is 
a general discoloration of the skin, which is of a dull black color. The cra- 
nium is very thick, and of small size. The dura-mater is very thick, and ad- 
herent to the cranium ; vessels of the arachnoid and pia-mater are injected ; 
the convolutions of the brain are small and close. The brain is soft, and 
there is serum at the base of the cranium, and in the two lateral ventricles. 
Adhesions of the walls of the ventricles are very strong, posteriorly ; there 
are slight adhesions with the striated bodies ; the capacity of the ventricles is 
very much diminished, and the vessels of the membrane that invests them are 
injected. The white substance is injected — the grey substance slightly color- 
ed, and the cerebellum soft. The left pleura is adherent throughout a great 



222 CRITICAL TERMINATIONS OF INSANITY. 

portion of its extent, and a mud-like serum effused through the rest of the ca- 
vity. The lung is infiltrated and in a state of suppuration, with numerous 
tubercles in the same condition. The right pleura presents only certain ad- 
hesions, but the superior portion of the lung is tuberculous, with some points 
of suppuration. There is an abundance of serum in the pericardium. The 
liver is soft, the gall-bladder containing bile. The urinary bladder is greatly 
contracted, and its walls very thick. The uterus is voluminous but healthy ; 
and the vagina presents traces of leucorrhcea. The mucous membrane of the 
stomach is slightly phlogosed, and coated with a greyish mucus. The trans- 
verse colon is precipitated behind the pubes. 

Manceau, a single woman and a seamstress. At thirty years of age she is 
married and meets with trials, from which mania and melancholy ensue. Se- 
veral times in the course of the year, she suffers from nervous agitation. At 
thirty-six years of age, fury is almost continual, and provoked by the slightest 
opposition. At a later period, she was accustomed to run through the fields 
with a devotional book in her hand. She was not mischievous. Thirty-seven 
years of age. Admitted into the hospital June 10th, 1806. She is much ema- 
ciated, very wild and furious. Her menses are regular, and her eyes haggard 
and threatening. She remains habitually upon the bed, yet never using the 
coverings of it. During the warmest weather, she rises and remains seated 
upon her heels, always in the same place. She remains by herself, speaks to 
no one, but provokes all by her abuse. She is very mischievous, and strikes 
with the intention of doing much injury. She then becomes pale, and her 
eyes gleam. Slie is uncontrollable, and still threatens, though surrounded by 
a great array of force. She is unwilling to labor, but demands permission to 
return home, because she is very rich. She is insolent, and prodigal of the 
appellations of robber, rascal, etc. At night she is tranquil. She is very 
neat. She eats, but her appetite is capricious. Forty-two years of age, Oct. 
1811. For some months her menses have been irregular. She is sick, but 
refuses aid. December. Very copious uterine hemorrhage. Since this time 
she often remarks that she is sick, and falls into marasmus, without any dimi- 
nution of her fury. March 6th, 1812. Fever. 8th. Involuntary dejections, 
adynamic symptoms and fever. 9th. Admitted into the infirmary, where it 
was necessary to restrain her. Tongue and teeth black, fever, involuntary 
dejections, thirst. 10th. Respiration frequent, prostration. 11th. Death 
took place at eleven o'clock in the morning. 

Autopsy, 12th. Marasmus, hair grey. Skin brown and sunburnt ; oedema 
of the feet, and scurvy spots. Cranium irregularly thickened, median line 
turned to one side, parietal protuberances very much enlarged, fosscB at the base 
of the cranium, unequal. A mass of membraniform blood, over the whole in- 
ternal face of the arachnoid. Falx reticulated. Vessels of the external lami- 
na of the pia-mater injected, more particularly at the left. Serum between 
the two lamina; of the pia-mater. Serum at the base of the cranium. Pineal 
gland presents osseous concretions. The ventricles adhere anteriorly to the 
striated bodies. Plexuses discolored. Grey substance discolored. Cerebel- 
lum very soft. Left lung hepatized, presenting some tubercles, two or three 
of which are in a state of suppuration. Hydropericardium. Transverse 
colon depressed even to the pubes. The stomach contracted ; its folds pre 
senting traces of inflammation, and the mucous surface coated with a greyish 
mucus. Intestines inflamed at various points, and of a dark color. Matrix 
scirrous. 

Buel was twenty-eight years of age at the time of her admission into the 
hospital of the Salpetriere, Dec. 11th, 1808, in consequence of religious me- 
lancholy. The patient still menstruated, but the discharge was scanty. This 
woman had almost nightly, drjluxions from the head, and an habitual cepha- 
lalgia. She ate little, and remained much of the time in bed. Her delirium 



CRITICAL TERMINATIONS OF INSANITY. 223 

was founded on religious notions, and she was in the habit of saying that she 
was retained in the house by villians. She treated her companions with con- 
tempt, nor did she associate with them, and lived aside and alone. When 
thirty-one, she no longer complained of cephalalgia, nor did she suffer from 
defluxions ; but became more feeble, and lost flesh, although her appetite was 
very good. She often coughed. Her complaints were accompanied with me- 
naces, cries and abuse. July, 1812. Thirty-two years of age ; defluxion from 
the head, cough, time in bed prolonged, extreme feebleness. July 14th, ad- 
mitted into the infirmary. Phthisis, fever. Aug. 6th. Cough, dyspnoea, and 
febrile paroxysms every evening. 19th. Purulent expectoration, diarrhoea, 
and oedema of the feet. 21st. Cessation of the diarrhoea, oedema of the 
hands and feet, dyspnoea, delirium. 23d. Death at 9 o'clock in the morning. 
24th. Post-mortem examination. She was tall, hair light, eyes blue, skin 
white; thoracic members emaciated; abdominal, infiltrated; submaxillary 
glands enlarged. Cranium thin and hardened, the dura-mater is adherent to 
the cranium, and that portion which lines the middle fossae of the base of the 
cranium is reticulated. There is serum between the pia-mater and the arach- 
noid. The convolutions of the brain are close, and of little depth. The 
grey substance is discolored, and a reddish serum is found in the lateral ventri- 
cles, whose capacity is very much diminished, by the adherence of their pos- 
terior walls. Serum containing flocculi, is met with in both pleurae, which 
adhere closely to the lungs. The latter present tubercles, of which some are 
in a state of suppuration. There is serum also, in the pericardium and abdo- 
men. The liver is granulated in its aspect, and the gall-bladder distended 
with fluid bile, of an orange color. The alimentary canal is distended by 
gases, the transverse colon extending even to the pubes. There are certain 
reddish and even ulcerated points of the mucous membrane of the stomach 
and intestines ; the mesenteric glands are enlarged. 

A widow St. D. was thirty-six years of age when she entered the Salpetri- 
ere, Jan. 5th, 1807, in consequence of melancholy, with attempts to commit 
suicide. Having lost her husband at the age of twenty-eight years, she griev- 
ed excessively, and sunk into great mental depression. Though the mother 
of several children, she immediately became sad and gloomy, and a prey to 
imaginary terrors. Pursued by her fears, she threw herself from a window, 
with one of her children in her arms. Though treated at the Hotel Dieu, 
and by several physicians, nothing could compose her terrified imagination. 
At the age of thirty-six years, when admitted into the hospital, she was very 
much emaciated, remained much in bed, menstruated regularly, ate much, 
accused herself of divers crimes, and wished to be crucified. She made seve- 
ral attempts to destroy herself We soon perceived, that she had given herself 
up to the practice of masturbation. Every winter, she suffered from very se- 
vere catarrhal affections, for which she passed several months in the infirmary. 
Thirty-nine years of age. She appeared to be relieved of her religious terror, 
and spoke of holy things without dread. There was more connection in her 
reasonings, but her disposition became insupportable. She complained of, 
and was dissatisfied with every thing, accusing the persons who served her, 
with negligence or unkind treatment. She abused every one, vexed her asso- 
ciates, and gave them bad advice. Forty years. During the winter the men- 
ses cease. Since that period, she has had a continual couorh, and has sensibly 
grown worse. She frequently suffers also, from a diarrhoea. Forty-one years 
of age. Oct., 1811, enters the infirmary. There is emaciation, cough, ex- 
pectoration, fever, and capriciousness with respect to her mode of living, 
feebleness and night sweats. This woman is not irrational, but sad, taciturn, 
and very irritable. Jan. 5th, 1812. Serous and fetid diarrhoea, purulent ex- 
pectoration, a very painful cough, and oedema of the feet. 15th. Extreme 
feebleness, and alteration of the features of the face : paroxysms every evening. 



224 CRITICAL TERMINATION S OF INSANITY. 

18th. Incapable of taking solid aliment, the vital forces are sustained with a 
little broth and wine. Expectoration and alvine dejections very abundant and 
fetid. 24th. Cessation of the diarrhoea, suppression of the expectoration and 
dyspnoea. At evening she feels that her last hour is approaching, wishes her 
waiting maid good nicrht, and dies. 25th. Post-mortem examination. Hair 
black, emaciation, cranium thin and hardened ; the median line dividing the 
head into two unequal parts. Meninges very much injected, serum between 
the pia-mater and arachnoid membrane ; a reddish serum at the base of the 
cranium, as well as in the lateral ventricles, whose walls adhere posteriorly. 
The lungs adhere to the costal pleurae, and contain tubercles, of which a great 
portion are in a state of suppuration. The mesenteric glands are enlarged, 
and several of them are reduced to a puriform substance. The transverse 
colon extends towards the pubes. The liver is soft and fat, and the gall blad- 
der contains very brown bile. The spleen adheres to the diaphragm. There 
are several ulcerated points upon the mucous membrane of the intestines. 

M., forty-three years of age, of an athletic figure, and sanguine tempera- 
ment, had yielded himself, from his earliest youth, to the control of an unbri- 
dled ambition. He had held trusts of great importance ; but for sonietinie, 
had filled a station of but secondary consequence. This disappointment ren- 
dered him sad, without lessening his pretensions. His disposition changed, 
and he became choleric and difficult in his intercourse with societv. He com- 
mitted errors of conduct, the publicity of which exposed him. He became 
irritated at the counsels of his relatives and friends, until, at length, his con- 
duct was that of a maniac, although there was no wildness in his conversation. 
The moment they manifest a desire to oppose this conduct, he becomes furi- 
ous, and dangerous to all who approach him, even to his family. He was 
committed to my care. He is tall, his face flushed, eyes injected and shining. 
He is also loquacious, utters cries, menaces those about him, and uses abusive 
language. He calls himself a king, and requires the attentions due to royalty ; 
treating with disdain all those whom he meets. These wild pretensions be- 
came every instant the cause of new irritations, opposition and outbreaks of 
fury. He suffers from insomnia, thirst, and constipation. It is easy to per- 
ceive, that at times, the patient with difficulty utters articulate sounds. Leeches 
to the anus and temples renewed ; acidulated drinks ; prolonged tepid baths. 
After two months we employ douches of cold water to the head, while the 
body of the patient is immersed in tepid water. Composure is gradually es- 
tablished. He has lucid intervals ; but the conviction that he is a great per- 
sonage ever remains. At the expiration of five months, the patient becomes 
fleshy, and the paralysis of the tongue more apparent. He is perfectly calm ; 
his appetite and sleep are excellent, but his notions of grandeur persist. The 
patient gradually becomes exceedingly fleshy. He walks with difficulty; and 
it is with no little inconvenience that he makes himself understood. His me- 
mory is enfeebled, especially that for things present. We apply at first, a 
large blister to the neck ; then a seton. Valerian, bark and drastics are em- 
ployed alternately. At the expiration of fifteen months' illness, a frightful 
attack of apoplexy terminates the existence of the patient. The cellular tissue 
is surcharged with fat. The integuments of the head are very much injected, 
as well as the membranes of the brain, which is dense. The liver is fatty, 
and voluminous. The intestines are distended with gases ; trichurides are 
found in the coecum. The transverse colon having become perpendicular, 
is concealed behind the pubes by its splenic extremity. 

The facts related above, present a pathological phenomenon, which has not 
yet been particularly referred to. Both the ancients and moderns who have 
treated of mental alienation, and particularly of melancholy, have all spoken 
of lesions of the abdominal viscera ; but no one, of the displacement of the 
transverse colon. However, we often find this intestine displaced, in our post- 



LYPEMANIA OR MELANCHOLY. 225 

mortem examinations of the insane. Its direction is now oblique, now per- 
pendicular, so that its left extremity is brought behind the pubes. Sometimes 
the transverse colon descends in the form of an arc, below the pubes, and 
within the pelvic cavity. This displacement cannot depend upon a mechani- 
cal action, resulting from a thickening of the walls of the colon, or from the 
accumulation of matters within it ; for in the greater number of subjects that 
I have examined, the colon was empty, and all the membranes composing it, 
healthy. The same is true of the ascending and descending portions of the 
colon, which by their traction might draw down the transverse portion. This 
displacement is not the effect of the last and fatal disease of the patient ; for 
this phenomenon is observed among individuals who have fallen victims to 
different maladies. The insane, and particularly melancholies, among whom 
we observe this displacement of the transverse colon, often complain of epi- 
gastric pains. They remark, that they experience a pain similar to that which 
a band would produce, girded about the hypochondria. The dejections are 
generally morbid. Do not these symptoms furnish an explanation of the dis- 
placement of the colon ? Had not the ancients by giving hellebore, and the 
moderns, in prescribing emetics and drastics in the treatment of mental alien- 
ation, and especially in melancholy, both by means of evacuants, had for their 
object, to restore the tone of all the abdominal viscera ? Are not laxatives 
regarded as injurious, because they augment the relaxation 1 and are we not 
always exceedingly careful to combine them with tonics ? Do not sea-voyao-es 
in fine, and exercise on horseback, so useful in melancholy, produce their be- 
neficial effect by strengthening the abdominal viscera ? 

The knowledge of these facts has appeared to me interesting; 1st, because 
displacement of the colon is frequent among the insane, particularly melan- 
cholies ; 2d, because this information may render more sure and rational, 
the treatment of some cases of disease. The post-mortem examination of 
one hundred and sixty-eight lypemaniacs, has revealed the following lesions. 
It proves that a great many melancholies succumb to phthisis pulmonalis ; and 
that alterations of the abdominal viscera are also very frequent ; whilst orga- 
nic changes of the brain are rare ; for we should not attribute melancholy to 
the effusions which we observe in the sinuses and meninges of the brain. 
We say the same with respect to the osseous concretions, so frequent in the 
conarium, (pineal gland). 

Table of Pathological Lesions found in the bodies of Lypemaniacs. 

Thickening of the meninges . . .2 

Organic lesions of the brain ... 4 

Cranium. <( Points of ossification adhering to the falx . . 3 

I Sanguine effusions into the sinuses or substance of the 

(^ brain ...... 5 

C Organic lesions of the lungs . . .65 

T%orax. -^ Lesions of the heart . . . .11 

(^ Serum in the cavities of the chest . . ,6 

^ Colon displaced .... 33 

Adhesion, and suppuration of the peritoneum . 5 

Ulceration of the stomach or pylorus . . 6 

" " intestines or rectum . . 7 

Abdomen, -l Intestinal worms .... 5 

Tenia . . , . . ,1 

Organic lesions of the liver ... 2 

Biliary concretions . . .. . .7 

Ulceration of the uterus ... 6 



Total 168 

29 



226 LYPEMANIA OR MELANCHOLY. 

In comparing the maladies which terminate the lives of lypemaniacs, with 
those by which the existence of those suffering from other forms of mental 
alienation is brought to a close ; by comparing also the results of cadaveric 
examinations of melancholies, with those which we observe in the cadavera 
of those who have been affected by other forms of insanity ; one is struck 
with the predominance of pulmonary maladies among melancholies, as well 
as with the frequency of the abdominal changes. Lypemaniacs however, like 
other insane persons, rarely fall victims to acute maladies, but in general, to 
diseases of a chronic character. 



TREATMENT OF LYPEMANIA. 

The treatment of melancholy with delirium, like that of other forms of 
mental alienation, ouaht not to be limited to the administration of certain 
medicines. We must, before commencing the use of medicine, be thorough- 
ly convinced, that this is a malady obstinate and difficult to cure ; and that 
moral medicine, which seeks in the heart for the cause of the evil, which 
sympathizes and weeps, which consoles, and divides with the unfortunate 
their sufferings, and which revives hope in their breast, is often preferable to 
all other. We must be well informed of the remote and proximate causes of 
the disease, and its treatment may be either hygienic, moral or pharmaceutic. 
Hippocrates and the ancients, the Arabians and the moderns, have all observ- 
ed, that the state of the atmosphere exercises a remarkable influence over the 
intellectual and moral faculties of man. A dry and temperate climate, a clear 
sky, a pleasant temperature, an agreeable situation with varied scenery, are 
well adapted to melancholies. English physicians are careful to send their 
melancholic patients into the southern provinces of France and Italy, thus 
protecting them against the moist and oppressive air of England. 

M., a native of Belgium, forty-two years of age, of a strong constitution, 
and transacting a very large business, consults me at the close of the winter 
of 1825. Observe the account which is given me by him. " I have always 
enjoyed good health, am happy in my family, — having an affectionate wife 
and charming children. My affairs are also in excellent condition. Three 
years since, I experienced a trifling vexation. It was at the beginning of 
autumn, and I became sad, gloomy and susceptible. By degrees I neglected 
my business, and deserted my house to avoid my uneasiness. I felt feeble, 
and drank beer and liquors. Soon I became irritable. Every thing opposed 
my wishes, disturbed me, and rendered me insupportable, and even dangerous 
to my family. My affairs suffered from this state. I suffered also from in- 
somnia and inappetence. Neither the advice nor tender counsels of my wife, 
nor that of my family, had any more influence over me. At length, I fell into 
a profound apathy, incapable of every thing, except drinking and grieving. 
At the approach of spring I felt my affections revive. I recovered all my in- 
tellectual activity, and all my ardor for business. I was very well all the en- 
suing summer, but from the commencement of the damp and cold weather of 
autumn, there was a return of sadness, uneasiness, and a desire to drink, to 
dissipate my sadness. There was also a return of irascibility and transports 
of passion. During the last autumn and present winter, I have experienced 
for the third time the same phenomena, which have been more grievous than 
formerly. My fortune has suffered, and my wife has not been free from dan- 
ger. I have now come to submit myself to you, sir, and to obey your direc- 
tions in every thing." 

After many questions, I offered the following advice. A hospital will not 
benefit, but on the contrary, injure you. I will refer you to a physician who, 
during the whole summer will watch over your regimen, and accompany you 
in your excursions to the environs of Paris. You should bathe often, and 
from time to time, drink of the Sedlitz water. Your food should be of a ve- 



LYPEMANIA OK MELANCHOLY. 227 

getable character. In the month of September, you should go to Languedoc, 
and must be in Italy before the close of October, from whence you must not 
return until the month of May. This counsel was closely followed. At the 
close of December he was at Rome. He felt the impression of the cold, and 
the beginnings of a desire to drink were manifest, but shortly disappeared. 
He escaped a fourth attack, by withdrawing himself from the coldness and 
moisture of autumn. He returns to Paris in the month of May, in the enjoy- 
ment of excellent health. I could relate many similar facts. 

The clothing should be warm, and often changed, particularly the stock- 
inors ; melancholies being particularly subject to cold feet. They ought to 
proscribe salted, spiced, irritating and fatty articles of food, and all others 
that are difficult of digestion. Fresh meats, roasted, and chosen from among 
those of young animals, together with vegetable food, are adapted to this class 
of patients. They should abstain from farinaceous vegetables, giving the pre- 
ference to herbaceous legumina and fruits, especially those that contain in 
the greatest abundance, a mucilaginous and saccharine principle. Such are 
the red fruits of summer, grapes, oranges, pomegranates, etc. Fernel, Van- 
Swieten and Lorry, cite examples of melancholies, who were cured by the 
use of the fruits of summer ; they might have added, by the very abundant 
use of the grape. Exercise, in whatever manner it may be taken, is, without 
contradiction, one of our great resources, in combating lypemania. Tra- 
veling, which acts upon the brain by the impressions which it produces, caus- 
ino- as it were, a multitude of ideas and images, which are constantly renew- 
ed, to pass through the mind ; necessarily destroys that fixedness of the 
thoughts and concentration of the attention, which are so trying. Patients 
who cannot travel, ought to take exercise, and seek for diversions by excur- 
sions on foot and by carriage-rides, by corporeal exercises, by the cultivation 
of the earth, by taking charge of a garden, by family occupations and the 
practice of some profession. Equitation excites the activity of the abdominal 
viscera ; favors transpiration ; reposes and diverts the attention. We some- 
times obtain happy results from setting patients to carriage-driving. The 
Englishman struggles against the spleen, by taking the place of the coachman, 
and driving through the streets of London. The celebrated Alfieri rendered 
his deep melancholy supportable, by this means. The chase may be made to 
fulfil the same indications ; but we should be cautious how we entrust arms 
to those who entertain any disposition to commit suicide. Pinel expresses the 
wish that all hospitals for the insane should have connected with them a farm, 
on which the inmates may labor. Doctor Langermann had almost effected 
this purpose at the hospital of Bareuth, of which he was physician.* 

Dr. Horn has provided the insane of the hospital of Berlin, with all the 
means of exercise, compatible with their security, and he derives from it 
great advantages. At the Salpetriere, a good number of our insane women 
occupy themselves in sewing, knitting, and other manual exercises. Some 
engage in the cultivation of the garden, and many are occupied in the service 
of the hospital. These active occupations contribute to the number of cures 
obtained at this House. It is not so easy to furnish men with the implements 
of labor, because they may abuse them. Individuals who are not accustomed 
to any occupation, when there are insuperable difficulties in the way of their 
traveling, riding on horseback, or by carriage, ought to exercise themselves at 
games, which repose the mind and fatigue the body. Such are the shuttle- 
cock, tennis, the foot-ball, billiards, etc. But, to exercises of the body, we 
should join those of the mind. Study contributes to the cure of melancho- 

* For more than thirty years, we advised labor, and labor upon the soil particularly. 
At this day, the precept is every where invoked, and put in practice in Germany, Eng- 
land and France. 



228 LyPE MANIA OR MELANCHOLY. 

lies, provided that they do not apply themselves io objects calculated to exalt 
the imagination. Sometimes also, we favor melancholy ideas, by what we 
hope may cure. 

M. Charpentier, in his excellent thesis on melancholy, tells us that an eccle- 
siastic, who had become melancholic, with a disposition to suicide, in conse- 
quence of the misfortunes of the revolution, was relieved of this condition, 
by means of his active efforts in defending the concordat, which was favora- 
ble to the independence of the clergy. A man persuades himself that his 
enemies have stripped him of his whole fortune. He becomes sad, morose, 
and refuses to eat, because he has nothing wherewith to purchase food. He 
is sent to Paris. After the lapse of several months, I advise one of his friends 
to feign a suit, and persuade the patient to consult an advocate. The latter, 
understanding our object, demands a written memorial, in order the better to 
understand the situation of his client's aftairs. After hesitating for some days, 
he commences a long account, which requires many excursions, and even short 
journeys. A month had scarcely elapsed, and even before the memorial was 
completed, when it became evident that the disease began to improve, the 
cure of which was speedily accomplished. Alibert relates an analogous case. 

Isolation is ordinarily favorable, even when it is absolute. Solitude exer- 
cises a mysterious power, which reestablishes the moral forces that have been 
exhausted by the passions. Tepid baths prolonged, are of evident benefit, in 
reestablishing the transpiration; and all physicians, from the time of Galen to 
our own day, have boasted of their utility, and diligently recommended their 
use. The excretions seem to be almost altogether suspended in lypemania ; 
transpiration no longer takes place ; and the urine is retained sometimes for 
one, two, and even five days. Constipation is obstinate, and persists for weeks 
and months. Forestus speaks of an old man, who was for three months with- 
out an alvine evacuation. Such a degree of constipation is not always free 
from dancrer, as it sometimes occasions intestinal inflammation. We must over- 
come it, by means of the quality of the aliments and drinks ; by the use of ene- 
mata, fomentations to the abdomen, hip baths, etc. Although continence may, 
in rare instances, be a cause of melancholy ; it is not less true, that in some cir- 
cumstances, the spermatic evacuation has effected its cure. It may be how- 
ever, that the moral impression has been more favorable than the evacuation 
itself It is not easy to establish the degree of influence which, in this act, 
belongs, respectively, to the physical and moral impression. Aetius has 
spoken too strongly of the advantages of coition, which he prescribes as a 
specific. I can oppose many contrary facts, to the few rare examples that are 
offered in favor of this view. 

In examining the various hygienic means of relief, I have pointed out most 
of the important rules that are to be observed in the treatment of melancholy. 
It remains for me to speak of the employment of the passions, in the cure of 
this class of cases. Nothing is more difficult than to control the passions of 
man in health. How greatly augmented is the difficulty, when we wish to 
direct those of the insane ! A certain address is necessary, and great skill in 
seizing upon the infinitely diversified shades, which the application of the 
moral treatment presents, and to determine upon a fitting opportunity for this 
application. Now, we must oppose, and conquer the most obstinate resolu- 
tions, inspiring the patient with a passion, stronger than that which controls 
his reason, by substituting a real for an imaginary fear ; now, secure his con- 
fidence, and raise his fallen courage by awaking hope in his breast. Each 
melancholic should be treated on principles resulting from a thorough acquain- 
tance with the tendency of his mind, his character and habits, in order to 
subjugate the passion which, controlling his thoughts, maintains his delirium. 
Melancholies who are under the dominion of superstition, ought to avoid read- 
ing and conversation on subjects veiled in mystery. It is rare that we can 



LTPEMANIA OR MELANCHOLY. 



229 



swerve with impunity from this precept. It ia generally, after having read 
books calculated to exalt the imagination, after having given up the mind to 
exaggerated religious practices, and listened to sermons which lead astray the 
religious sentiment, that the delirium of melancholy assumes its most fatal 
character. The cures that are reported, and attributed to religious influence, 
need proof I have made many attempts to establish their correctness. I 
have called to my aid many and very respectable ecclesiastics, but rarely with 
success. A man is in despair in consequence of not having obtained a cer- 
tain place, and considers both himself and family dishonored. Religious in- 
fluences might effect a cure in this case, by producing a diversion in the 
prevailing ideas, and impressing him with a sense of the vanity of earthly 
things. A demonomaniac however, does not regard the advice of an ecclesi- 
astic. I have seen insane persons, who were far from religion before their 
sickness, become, after their cure, sincere believers, fulfilling, with great re- 
gularity, the duties of religion. They were convalescent, when they openly 
embraced a religious life. One of these individuals, a man of great worth, 
and who for a long time discharged important public duties, was brought to 
entertain a religious belief, to which he had before been a stranger, by the re- 
eollection of what he had experienced during his delirium. When love is the 
prevailing passion, it is often the case that nothing less than the object be- 
loved will eflfect a cure; amore medico sanatur amor, (Ovid). Every one is 
acquainted with the cure wrought by Erasistratus, who restored the son of 
Seleucus, by inducing this prince to sacrifice to his son, his love for Strato- 
nice. Areteus speaks of one Crotoniatus who was cured, only by the posses- 
sion of the object beloved. If there are insurmountable obstacles to this 
mode of relief, some physicians have not feared to recommend the counsel 
of Ovid. A sudden, strong, and unexpected emotion, a surprise, fear and ter- 
ror, have sometimes been successful. Spasmo spasmus solvitur, says Lorry. 
Means, more or less ingenious, have been devised to remove convictions, and 
to break the chain of strange ideas. A thousand circumstances may furnish 
the physician, or bring to mind indications for intellectual and moral therapeu- 
tics. The following facts may furnish useful hints. We find them in every 
collection of cases, and in various parts of this work. Alexander of Tralles, 
cures a woman who thinks she has swallowed a serpent, by throwing one into 
a vessel in which she was vomiting. Zacutus tells us, that a young man who 
believed that he was damned, was cured, by introducing into his apartment, a 
man disguised so as to represent an angel, who announced to him the pardon 
of his sins. Ambrose Pare cures a patient who thought he had frogs in his 
abdomen, by purging him, and putting frogs, by stealth, into his night vessel. 
A demonomaniac refuses every kind of nourishment, because he thinks him- 
self dead. Forestus succeeds in inducing him to eat, by presenting to him 
another dead man, who assured him that people of the other world eat very 
well. Alexander of Tralles informs us, that Philotinus undeceived a man 
who thought he had no head, by causing him to wear a bonnet of lead, whose 
weight finally informed him of his error. A melancholic believes that he can 
never again urinate, without subjecting the world to the risk of a new deluge. 
They inform him that a fire threatens the destruction of the city, and that 
unless he consents to urinate, all is lost. He decides to comply with their 
request, and is cured. 

A young man is unwilling to eat, because his friends and relatives will be 
dishonored thereby. One of his friends arrives, all out of breath, and brings 
a declaration of the government, which frees him from all dishonor. The 
patient, who had passed thirteen days without food, on receiving this intima- 
tion, eats immediately. Pinel relates, that while physician at the Bicetre, he 
made up a mock, court, which tried a melancholic, who thought himself guilty. 
This stratagem succeeded, but its success was short, in consequence of the 



230 LYPEMANIA OR MELANCHOLY. 

imprudence of one of those who were in the secret, who informed the man 
that we had made sport of him. The same author relates in his Treatise on 
Mania, many examples of monomaniacs, whose imaginary fears and obstinate 
repugnances had yielded to a real fear, caused by the appearance of a great 
degree of constraint. Pain has also triumphed over the obstinacy of some 
patients. 

A lady was committed to my care, who thought that she was damned, and 
had the devil in her, and was cured, through fear of cold baths, which she 
dreaded beyond measure, and with which she was threatened, every time that 
she abandoned herself to her peculiar notions and chimerical fears. We suc- 
ceed also, by persuading lypemaniacs that they have no possibility of accom- 
plishing their design. Thus, a young person, who had been disappointed in 
a love affair, having, for seventeen days, refused to take food, in order to ter- 
minate her existence, was restored to health, after being obliged to take food 
by means of the tube, and had become satisfied, that in spite of all her 
efforts, they could nourish her, and prevent her dying of hunger. 

I have seen the substitution of one passion for another cure lypemania, by 
addressing itself to the self-love of the individual, arousingf and exaltinor it. 
I have silenced imaginary terrors thereby, and have seen love take the place 
of delirium depending on melancholy, in the case of two or three young lype- 
maniacs of the Salpetriere. We should be cautious in the employment of 
fear, and especially terror; as these passions produce a sedative action, which 
may occasion the gravest consequences. The effects of music, to which the 
ancients have attributed so many miracles, is more beneficial in melancholy 
than in other forms of mental alienation. Galen assures us, that ^sculapius 
was accustomed to cure diseases of the mind, by songs and harmony. We 
read in the history of music, and in the writings of physicians, examples of 
cures effected by this means. In order to render it efficacious, we must em- 
ploy a small number of instruments, and select airs adapted to the condition 
of the patient. The treatment which applies itself directly to the organic 
sensibility, and which we call physical treatment, when it is seconded by hy- 
giene, and is not directed by empiricism, but by systematic views, certainly 
contributes to the cure of lypemania : for if this malady is often produced by 
the moral affections, it is also, by physical derangements. It is the result of 
observation, that all forms of mental alienation, and melancholy in particular, 
offer the best chance of cure, when the physician can perceive some disorder 
in the functions of assimilative life. 

Let us suppose the nature of the pathological causes which have produced 
melancholy, to be fully understood ; our therapeutic views will be directed in 
accordance with this information. If there be suppression of the menses, or 
hemorrhoids, we must reestablish these evacuations; if the retrocession of 
herpes, we act upon the skin, etc. It would be superfluous to enter into de- 
tails, as physicians are aware that they often have to do with melancholy de- 
pending upon similar causes. It is not always easy to go back to causes so 
evident ; and lypemania is treated conformably to the theories and systems 
that have prevailed, at different epochs of medicine. The ancients, regarding 
this malady as produced by bile, black bile, or a corroding humor, employed 
evacuants, especially purgatives. Hellebore was the remedy preferred to all 
others, in melancholy, and its use has passed into a proverb. That of Anty- 
cira was preferred to any other. Celsus recommends the white hellebore in 
gay or cheerful monomania, while he prescribes the black in lypemania, or 
melancholy with sadness. Some moderns have desired to return to the use of 
hellebore. They propose to purge with it: but we do not want for other me- 
dicines, better known, more sure and less dangerous ; for practitioners who 
extol extravagantly the use of this root, by no means accord to it a specific 
virtue. Pinel confines himself to gentle laxatives, or mild purgatives. The 



LYPEMANIA OR MELANCHOLY. 23 1 

chicoria, and saponaceous plants, combined with certain neutral salts, are 
sufficient to obviate constipation, whether it announces an attack or paroxysm, 
or complicates the melancholy. At the commencement of lypemania, emetics 
and emeto-cathartics are very useful. We find it well also, to maintain an 
artificial diarrhoea, when the strength will permit it, thus imitating nature in 
one of her means of cure. Enemata, more or less irritating, also produce 
some benefit. Evacuants are adapted chiefly to that form of melancholy 
which is characterized by supineness, an aversion to action, and torpor of the 
functions. 

We administer the Tartrate of Antimony and Potassa, in small and repeat- 
ed doses, either for the purpose of relieving irritation, or to act upon the ima- 
gination of patients who think themselves well. The gastric or intestinal 
pains which they experience, attract their attention, persuade them that they 
are sick, and determine them to employ suitable remedies. With some me- 
lancholies who refuse every kind of medicine, we employ energetic substances 
in a small volume, and cause them to be taken without the knowledge of the 
patient, mingled with his food or drinks. Such are gamboge, scammony, 
jalap, aloes, calomel, etc. Darwin has lately added to our list of remedial 
agents, a machine, which he denominates a rotatory machine, the effect of 
which is to produce abundant evacuations, both by the mouth and bowels. 
Some English physicians, among whom are Mason Cox, and Haslam, boast 
greatly of the happy effects produced by this machine, of which I first caused 
a model to be made in France. Some physicians have feared lest the use of 
it might be more injurious than useful. It provokes epistaxis, occasions fears 
of apoplexy, prostrates the patient exceedingly, produces syncope, and exposes 
to other accidents, more or less alarming in their character, which have caus- 
ed it to be rejected. 

Pursuing the atrabile into the circulation, the humorists deduce from blood- 
letting a general precept against melancholy. Areteus alone among the an- 
cients, expressly defends it in the major part of cases. He permits it how- 
ever, only among young subjects, in the spring, and in small quantities. Cul- 
len says, that blood-letting is rarely useful. Pinel employs it very little. Ne- 
vertheless, we may have recourse to local sanguine evacuations ; now at the 
epigastrium, when the stomach is the seat of an active irritation ; now, to the 
vulva, when we wish to reestablish the menstrual flux ; or to the anus, when 
we desire to renew a hemorrhoidal discharge ; and finally to the head, when 
there are signs of cerebral congestion. I have sometimes applied leeches 
with success to the side of the head, when lypemaniacs complained of a fixed 
pain in the part. Lypemania does not always present itself in connection 
with symptoms, which indicate a predominance of the abdominal system, or 
turgescence of the sanguine system. Sometimes the nervous system appears 
to be alone the cause of all the difficulty ; and Lorry first correctly viewed 
and admirably described the character of this form of melancholy, which he 
most clearly distinguishes from that depending upon physical causes. In this 
form of melancholy, vulgarly called nervous, but by Lorry, melancholy not 
depending upon a physical agency, evacuants augment the evil. The physi- 
cian should endeavor to modify the .sensibility, and to calm the nervous ex- 
citement by hygienic measures already indicated ; by soothing drinks, by nar- 
cotics, by opium, by the use of water in vapor, in douches, by baths and affu- 
sions. The tepid bath is more or less prolonged, sometimes for several hours. 
The bath, by immersion in cold water, is useful when melancholy depends 
upon onanism. Affusions of cold water, by determining a nervous reaction 
to the surface, causes the internal spasm to cease, and brings about a happy 
termination of the malady. The douche acts in a similar manner, besides 
that, in the hands of an experienced physician, it may have a moral influence 
over the patient, and oblige him to renounce resolutions, both dangerous and 



232 LYPEMANIA OR MELANCHOLY. 

fatal. Some physicians, and particularly Teden and Leroi d'Anvers, have 
recommended the internal use of very large doses of cold water. They re- 
gard it as an almost infallible remedy against the disposition to suicide. 
The ancients made a very free use of narcotics. Lazare Riviere boasts of the 
good effects of opiates. Odier* states, that he cured a case of melancholy by 
the use of opium, gradually carried to the extent of thirty grains, and com- 
bined with an equal quantity of musk. We should not employ this article 
among plethoric individuals, or those disposed to sanguine congestions. 
Some enthusiasts have employed magnetism in the treatment of melancholy ; 
and what have they obtained 1 Results slightly advantageous, if not altogether 
doubtful. I have also made experiments with it, but have not obtained a sin- 
gle cure. 

After having rapidly unfolded the general considerations, which the study 
of lypemania, or melancholy with delirium presents, we ought to indicate the 
varied forms which the delirium of melancholy assumes ; but who could point 
out all these varieties ? Are they not as numerous as the modifications that 
the sensibility can experience 1 Do they not borrow their characters from 
some one or other passion, unduly excited by the imagination ? Although the 
cause of the disease remains always the same, the features which characterize 
each case of the affection, change and diversify themselves to infinity. I shall 
speak of a very small number of varieties only, which give rise to considera- 
tions of the hiofhest interest. 



o 



[The treatment of tliis form of mental disease recommended by our author, will be 
found to correspond for the most part with that pursued by the profession in this coun 
try,, and is quite at variance with the expectant plan, so popular with French practition 
ers The hygienic course which he advocates, is proved, both by examples given by him- 
self, as well as by a sufficient amo.unt of evidence elsewhere furnished, to be of incalcu- 
lable value to the lypemaniac. In his remarks on " Moral Influences," we regard his 
veiws as particularly happy. In his graphic description of the mental condition of this 
unfortunate class, he touchingly appeals in their behalf, to that sympathy and forbear- 
ance in our intercourse with them, which under all circumstances of affliction are so 
welcome, and the more, when a diseased and debilitated frame, is coupled with the de- 
pressing emotions. No apprehensions are more real, no fears more intense, no belief 
more honest, no convictions more strong, than those which torture the victim of melan- 
choly. Ilis imaginary notions, are to him awful realities ; and I am safe in saying that 
no other form of suftering can for a moment compare with this. Would all the morti- 
fication and regrets incident to ruinous reverses, induce the tender mother to raise the 
weapon of death over the head of her innocent offspring.'' Would she not rather bless 
God that this precious treasure was still spared to her .■' Yet the perverted maternal 
sentiment, leads but too frequently to the commission of acts, which the mind shudders 
to contemplate. Now the early symptoms of the malady which result in a catastrophe 
60 deplorable, are known by the common name of "hypo," and are regarded as an in- 
firmity which the unhappy suflierer may at any time sliake off. Hence that indifference, 
the cold look, and not unfrequently, the harsh and unfeeling expression, which aug- 
ment the agony which he now endures. From the first, the tenderest sympathy, those 
hygienic influences and medicinal agents, which are best adapted to restore the exhaust- 
ed energies, and overcome disordered organic functions, are demanded ; and if we fail 
in giving to each and every one of them its full measure of influence at an early day, 
we may see our unhappy friends doomed to a life of suff'ering which no pen can describe. 
The table which furnishes an account of the pathological lesions, found after death in 
one hundred and sixty-eight cases, is probably the most valuable of any, in this depart- 

* British Library, Geneva, 1816. 



LYPEMANIA OR MELANCHOLY. 233 

nient on record; both as furnishing a more satisfactory statement of the pathology of 
lypemania than any other, and as a consequence, the most appropriate mode of treat- 
ment. The number of post-mortem examinations made in the hospitals for the treat- 
ment of insanity in this country, are very few, and of this number fewer still are ever 
published. The cause is evident, and is not likely very soon to be obviated ; a circum- 
stance which gives additional interest and value to the table referred to. With respect 
to the medical treatment, it may be proper to remark, that drastic purgatives are very 
rarely requisite, and general blood-letting still less so ; while to obviate local conges- 
tions, topical depletion may sometimes be proper.] 



30 



DEMONOMANIA. 



Origin, history and signification of term. — Origin of religious melancholy. — Stellar and 
lunar influence. — Influence of the doctrine of the Platonists on mental alienation. — 
Origin of conjurations, sorcery, magic, witchcraft and astrology. — Influence of Chris- 
tianity on the form and treatment of insanity. — The eflTect of the reformation of Lu- 
ther and Calvin. — Mode of dissipating the errors which led to this form of insanity. — 
Analysis of symptoms of this malady, compared with those that attend other forms of 
melancholy. — Case. — Post-mortem examination.- — Cases. — Sometimes epidemic. — Ex- 
amples. — Demoniacal possession rarely occurs before puberty. — Women more subject 
to this disease than men. — Causes, physical and moral. — Its access generally sudden. 
— Demonomaniacs usually emaciated, etc. — Exhale a strong odor. — Ecstasies common, 
and modified by various circumstances. — Demonomaniacs suffer from hallucinations 
and illusions. — Case. — Tenacious of their delusions. — Examples. — Tests of demonia- 
cal possession. — Death often hailed with joy by the possessed. — Convulsions not un- 
common. — Important conclusions. — Suicide much to be feared in this form of insanity. 
— Of all insane persons, lypemaniacs are the most cruel. — Treatment. — Medical. — 
Moral. — Zoanthropy. — Lycanthropy. — Fatalists, or believers in destiny. — Several 
strange views referred to. — Examples, with a post-mortem examination. 

The word demon among the ancients, was not understood in a bad sense. 
It signified the Divinity, a tutelary Genius, a guardian Spirit ; dulftoviov^ is 
derived from dul/non'^ sapiens, sciens. Plato assigned this name to that Spirit 
with whom the Supreme Being intrusted the government of the world. The 
Jews, after the Chaldeans, attributed almost all diseases to the agency of 
spirits or demons. Saul is troubled by an evil spirit ; Job is the sport of a 
demon. The dysentery which smote Joram, was referred to the same cause. 
Nebuchadonosor is seized with lycanthropy by the command of God. Is it 
astonishing that hysteria, epilepsy and melancholy are called sacred? The 
Greeks also, charged the spirits with being the cause of the major part of 
their diseases. Herodotus affirms, that Cleomenes did not become furious 
in consequence of the presence of demons, but because he was intoxicated 
with the Scythians. Aristophanes denominates the most intense degree of 
fury, not /navlu^ but xuxodul/iovlu. By preserving the primitive signification 
of this word, we should have given the name of demonoraania to religious 
melancholy. The first variety of this form of insanity would have designated 
that class of the insane, who believe that they are God, who imagine that they 
have conversations and intimate communications with the Holy Spirit, angels 
and saints, and who pretend to be inspired, and to have received a commission 
from heaven to convert men. This species would have been denominated 
theomania ; while the second would have been called cacodcmonomania, and 



236 DEMONOMANIA. 

would have embraced all those unfortunate beings who fancied that they were 
possessed by the devil, and in his power ; who were convinced that they had 
been present at the imaginary assemblies of evil spirits, or who feared damna- 
tion, and the misery of eternal fire. This classification would present, in a 
single variety, all those forms of delirium which have reference to religious 
beliefs. It would place in opposition all the varieties of religious melancholy ; 
while the religious, gay and bold forms of delirium, attended with pride and 
exaltation of the faculties, would be, so to speak, placed in comparison with 
the sad and timid forms, attended by despondency and terror. But the word 
demonomania is appropriated; and the public would charge me with neolo- 
gism, were I to restore it to its etymological signification. 

Man, dependent by his organization upon external influences, and passing 
alternately from well-being to sorrow, from pain to pleasure, and from fear to 
hope, was naturally led to reflect upon the nature and relations of good and 
evil. He soon admitted the existence of a good being, and a malevolent spirit, 
which presided over his good or ill fortune. A step more only, and a system 
of theology was formed. Religion was now, gentle and full of consolation ; 
now, she assumed a severe and threatening tone. But sorrow having pervad- 
ed almost the entire existence of man, and pain being more extensively pre- 
valent in the world, ideas of a depressing character predominated. From sad- 
ness, to fear and terror, there was but a step. These sentiments inspired in 
the earliest period of the world, a sort of religious melancholy, depending 
upon those fearful terrors that had their origin with the birth of the world. 
Religious melancholy was, therefore, of all forms of mental alienation, the 
most general and extended. The sacred books of every people present ex- 
amples of it. When man, abandoning the worship of the true God, fell into 
idolatry, the first objects of his adoration were the stars. (Newton, chronol.) 
These most strongly impressed his senses, and exercised over him the most 
active and long-continued influence. Religious melancholy was regarded as 
dependent upon the course of the stars, and its periodicity strengthened this 
belief The insane were called maniacs, a word derived from «'/»''?, luna, 
lune, from which the Greeks made maniacs, moon-struck, and the Latins luna- 
tics ; an appellation which is still maintained in England, and also in France, 
in the language of common life. When the doctrine of spirits, taught by the 
Platonists, at length complicates their theological notions, nervous maladies, 
and particularly mental alienation, being sacred diseases, were attributed to 
the agency of spirits and demons. Among the insane, some were gay, bold and 
rash, regarding themselves as inspired. They believed themselves fortunate, 
and the friends of the gods ; and presented themselves, or were presented to 
the people, as those sent from heaven. They also uttered oracles on their 
own, and on account of the priests. Others, on the contrary, sad, timid, pu- 
sillanimous, fearful, and pursued by imaginary terrors, pronounced themselves 
condemned forever. They were treated as objects of celestial wrath, and re- 
garded themselves as devoted to the powers of hell. Meleager, CEdipus and 
Orestes, and many other illustrious subjects of divine wrath, were pursued by 
furies. These were true lypemaniacs. 

Disquietude, fear or fright, modified or changed the nature of all. They 
deemed it necessary to deliver themselves from some extraordinary evil, or to 
turn aside the vengeance of the gods. They desired also to read in the future, 
what they were to fear or to hope for. They evoked the souls of the dead, 
after having consulted the oracles and stars. The followers of Orpheus gave 
birth to the science of conjurations, sorcery, and many other mysterious prac- 
tices. Magic and witchcraft formed a part of their religious worship. Sove- 
reigns, legislators and philosophers, were initiated into the mysteries ; some, 
to extend the sphere of their knowledge, and others, from motives as shameful 
as criminal. Astrology, magic and witchcraft, all children of fear, so enchain- 



DEMONOMANIA. 237 

ed the imagination of men, that we need not be astonished, says Pliny, that 
their influence lasts so long, and has extended to all ages, regions and people. 
Christianity, by recalling religious views to the unity of God, by causing ora- 
cles to cease, and by enlightening men, rendered sacred the opinions of Plato 
and Socrates, respecting the existence of demons, and wrought a great revo- 
lution in the sentiments of men. They exaggerated the power of spirits over 
matter, and the fear of yielding to the instigations of the devil, created dread. 
They believed that from the commencement of this life, they were in the 
power of demons, and the number of demonomaniacs multiplied. This, the 
institution of exorcisms in the primitive church establishes. They had re- 
course to ceremonies and prayers to deliver the possessed, but did not burn 
them. They established, in several cities, solemn feasts for the cure of the 
possessed. They were accustomed to assemble in a church all the insane of 
a country, whither they came from the most remote regions. The concourse 
of people, assembled from every quarter, the presence of the bishop, the pomp 
and solemn display, the confidence which took possession of the sick, and 
every thing that could control their imagination, contributed to the cure of 
some of these unfortunate beings. They proclaim it a miracle, and this per- 
suasion prepared new cures for succeeding years. These solemnities, which, 
in some cities of France were still celebrated so late as the middle of the last 
century, must not be confounded with what they called the feast of mod-peo- 
ple, a strange saturnal, which took place in certain chapters, during the four- 
teenth and fifteenth centuries. 

When the impetuous Luther, on pretext of removing abuses, attempted to 
revolutionize the church in order to avenge his quarrels, religious discussions 
became the subject of all conversations, of all sermons, and even of all poli- 
tical reports. The diverse parties, reciprocally menaced each other with eter- 
nal damnation. Fanaticism was aroused, and religious melancholy added to 
all those ills that innovations had provoked. Calvin augmented them still 
more. We see none but the excommunicated, the condemned and wizards. 
The public were alarmed, created tribunals, the devil was summoned to ap- 
pear, the possessed were brought to judgment. They erected scaffolds, and 
kindled funeral piles. Demonomaniacs, under the name of sorcerers and 
possessed, victims in a double sense of the prevailing errors, were burnt, after 
having been put to the torture in order to induce them to renounce their pre- 
tended compact with the devil. In these unhappy times, such was the mania 
for attributing every thing to the agency of the devil, that Pierre de I'Ancre, 
not being able to comprehend how a rock, situated near a village of Asia, 
called Arpasa, of which Pliny speaks, and which, like the rock of Cydobre 
among the Albigenses, moves when one touches it with the end of the finger, 
while the most powerful efforts failed in producing this result, attributes this 
phenomenon to the power of a demon. G. E. Stahl* relates cases of grave 
maladies, which were reorarded as the work of the devil. 

Were this the place for it, I could prove that the insane had been employed 
to utter oracles, and that the priests knew how to inspire themselves with a 
holy delirium. I shall show farther on, that demoniacal possession is a true 
monomania. Demons became mute from the time that Christianity shed its 
benign influences abroad over the worldt. They ceased to plague men, so 
soon as men ceased to fear. They no sooner ceased to burn sorcerers and 
magicians, than the imagination became composed, and no longer gave birth 
to either of them. Many now fear the police, as they would formerly have 
done the stars and demons. This fear is so much the more intense and fatal, 
as the police acquires more influence in times of trouble and civil dissensions j 

* Collegium causale sic dictum minus. Swidnita, 1734, in 4to. 
t Fontenelle, History of Oracles, in 12mo. 



238 DEMONOMANIA. 

and we shall no longer be surprised, if in hospitals for the insane, demonoma- 
niacs are replaced by a class which fears the police, prison and punishment. 
It is ever the weakness of the human mind, pusillanimity, disquietude and 
fear, which acts upon these unfortunate beings, producing such results as were 
formerly regarded as demoniacal possession. That man is now in a mad- 
house, because he fears the police, who would formerly have been burnt be- 
cause he feared the devil. 

Physicians, and some men of superior wisdom, have, in all times, combat- 
ted the prejudices which caused the true sources of nervous maladies and 
mental alienation to be overlooked. Hippocrates or his disciples, in the trea- 
tise " On the Sacred Disease," assures us, that there can be no maladies 
caused by the gods. Areteus expresses the same sentiment. De causis morb. 
diut, lib. I. The report of Marescot, Riolan and Duret, respecting the pos- 
session of Martha Brossier, is a model of sound reason and wisdom. They 
reduce their opinion to these memorable terms : nihil a demons; multa Jicta, 
a morho pauca. " Nothing from the devil ; many things feigned : few things 
from disease." Cardan, Corneille Looz, Joseph Duchene, Bekker, Pigray, 
Bayle, Naude and Mead, defended these unfortunate beings against both the 
prejudiced and the Del-Rios, Bodins, Pierre de I'Ancres, etc. Malebranche, 
whose opinion should not be suspected, speaks with a noble boldness.* Par- 
liaments, under the presidency of Seguier, annulled many decrees, which con- 
demned to the flames both sorcerers and the possessed. All have read that 
beautiful passage of Aguesseau, where this celebrated magistrate says to par- 
liament, that in order to cause sorcery to cease, all that is necessary is, no 
longer to speak of sorcerers, and to attribute no kind of importance to the 
matter, but to commit, without noise, to the physicians, the wizards, who were 
" more sinned against, than sinning." Both sorcerers and the possessed 
were, in fact, often the victims of impostors, who made traffic of the igno- 
rance and superstition of their fellow creatures. They were imbeciles, me- 
lancholies and hysterical persons, who were believed to be possessed, because 
they had been threatened with demons and wizards ; and judges doomed these 
unhappy beings to the flames. A jurisprudence existed, having reference to 
sorcery and magic, as laws were enacted against robbery and murder. The 
people, seeing both Church and prince believe in the reality of these extra- 
vagances, remained invincibly persuaded. The more they pursued sorcerers 
and the possessed, and the more ceremony attended their punishment, the 
more was the number of these persons augmented, by exciting the imagina- 
tion, and occupying it with chimerical fears. A better education and the pro- 
gress of knowledge, have gradually dissipated these fatal errors, more success- 
fully than funeral piles, or legal code and digest. 

Though demonomania may be unusual at this day, it will not be uninterest- 
ing to point out and determine its characters. If the possessed no longer 
exist, there are still some monomaniacs who consider themselves in the power 
of the devil. I have collected certain facts respecting demonomania, and have 
compared them with what demonographers have related. Their resemblance 
has satisfied me that the symptoms that I observed are the same, with the signs 
of possession pointed out by authors, or contained in the accounts of the 
trials of sorcerers and those possessed. After having given a brief history 
of demonomania, we will pass on to an analysis and comparison of the symp- 
toms of this malady, with those that attend other forms of melancholy. 

A. D., a servant woman forty-six years of age, was of medium size, had 
chestnut colored hair, small hazel eyes, a dark complexion, and an ordinary 
degree of fulness of habit. Endowed with great susceptibility, she has much 
self-esteem, and was religiously educated. Fourteen years of age. Fir.st 

" Researches Concerning Truth; Paris, 1762, 4 vol. in 12mo. 



DEMONOMANIA. 239 

menstruation, and since that period the menses have been scanty and irregular. 
Thirty years. She becomes attached to a young man, whom they will not 
permit to marry her. She becomes sad and melancholic, believing herself 
abandoned by every body. The menses cease, not to appear again. She en- 
gages with extreme ardor in devotional exercises, makes a vow of chastity, 
and devotes herself to Jesus Christ. Sometime after this, she fails in her pro- 
mises, and remorse seizes upon her. She regards herself as condemned, given 
over to the evil one, and suffers the torments of hell. Six years she passes in 
this state of delirium and torments ; after which, exercise, dissipation and the 
influence of time, restore her to reason and her ordinary occupations. Forty 
years of age. Forsaken by a new lover, D. renews her vows of chastity, and 
passes her time in prayer. One day, while on her knees reading the imita- 
tion of Jesus Christ, a young man enters her chamber, says that he is Jesus 
Christ, that he has come to console her, and that if she will but trust in him, 
she will have no longer occasion to fear the devil. She yields. For the se- 
cond time she considers herself in the power of the devil, and experiences all 
the torments of hell and despair. Sent to the Salpetriere, she spends most of 
her time in bed, groaning night and day, eating little, continually complaining, 
and relating her misfortunes to all. Forty-six years of age, March 16th, 
1813. This woman is transferred to the infirmary for the insane. Her ema- 
ciation is extreme, skin earthy, face pale and convulsive, the eyes dull and 
fixed ; the breath fetid, the tongue dry, rough, and interspersed with whitish 
points. She refuses nourishment, although she says that she is tormented by 
liunger and thirst. There is insomnia, together with a small and feeble pulse, 
head heavy, with a burning sensation internally, and a feeling as if bound 
with a cord externally. There is a painful constriction of the throat, and she 
is constantly rolling up the skin of her neck with her fingers, and crowding it 
behind the sternum ; assuring us that the devil draws it, and that he strangles 
and prevents her from swallowing any thing. There is considerable tension 
of the muscles of the abdomen, attended by constipation ; and upon the back 
of the right hand and left foot, are scrofulous tumors. The devil has extend- 
ed a cord from the sternum to the pubes, which prevents the patient from 
standing up. He is in her body, burning and pinching it. He also gnaws 
her heart, and rends her entrails. She is surrounded by flames, and in the 
midst of the fires of hell, though we see them not. No one may credit it, but 
her ills are unprecedented, frightful, eternal. She is damned. Heaven can 
have no compassion upon her. 

April, 1813, diminution of the vital forces. The patient sees no one who 
approaches her. Day appears to her a light, in the midst of which wander 
spectres and demons, which reproach her for her conduct, threaten and mal- 
treat her. She refuses all consolation, and becomes irritated if we persist in 
offering it. The assistance of the ministers of religion is useless, and the 
aid of medicine rejected. This malady being never seen, men can do no- 
thing; a supernatural power is necessary. She curses the devil, who burns 
and tortures her, and God, who has cast her into hell. May 1813; marasmus, 
abdominal members retracted upon the abdomen ; decline of the vital forces, 
though the patient often says that she can never die. May 25th; tongue 
brown, burning heat, difficult respiration, thirst, pulse small and contracted. 
May 30th : feet swollen, chills at irregular intervals, though she has at the same 
time sensations of heat. Mournful groans. June 6th. A serous diarrhoea, 
feet swollen at times, the cheeks very much flushed, the tongue black, the 
skin earthy, pulse very small and frequent. June 15th : prostration, eschar 
over the coccyx, delirium the same. June 21st : aphonia, respiration fre- 
quent, pulse scarcely perceptible ; the same groans, the same delirium, and 
conviction that she should not die. June 22d. Death took place at seven 
o'clock in the evening ; for two days previous to this event, she could execute 
no movement, and swallowed nothing. 



240 DEMONO MANIA. 

June 24th. Post-mortem examination : marasmus, feet edematous, lower 
extremities retracted, eschars on the coccyx and sacrum. Cranium thickened 
anteriorly, diploe injected. Falciform fold of the dura-mater reticulated, and 
torn anteriorly. Serum at the base of the cranium. Some points of ossifica- 
tion in the Pineal gland. Cerebrum and cerebellum softened, grey substance 
pale. Serum abundant in the two lateral and third ventricles; plexus chor- 
rides discolored, having many small, serous cysts. Very extended adhesions 
of the posterior portions of the two ventricles. Lungs tuberculous, and adhe- 
rent throughout their whole extent to the pleurje. A small quantity of serum 
in the pericardium, to which the right auricle and point of the heart adhere. 
Epiploon atrophied, and interspersed with small black points, as was also the 
peritoneum throughout its whole extent. All the abdominal viscera, adhering 
closely together, form but a single mass of a brownish aspect ; mesenteric 
glands very much developed, and some of them, as large as hazel nuts, are 
converted into adipocere. The gall-bladder contains little bile, the spleen is 
reduced to the consistence of pap and the color of lees of wine ; the mucous 
membrane of the intestines is ulcerated in several points, and that of the uri- 
nary bladder reddish. The forehead is retreating, and very narrow from tem- 
ple to temple. The excessive flattening of the coronal region, gives to this 
profile one of the characters which have been pointed out as proper to 
idiocy. 

M., now forty-nine years of age, living in the country, and a wool-spinner 
by occupation, had often heard accounts of sorcerers. At fifteen years of age, 
the menses appear spontaneously. Thirty-seven. When on the point of mar- 
riage, she learns that her pretended lover is deceiving her. She will no longer 
listen to him, and a year after marries another person. He whom she has for- 
saken, threatens her with vengeance, and dooms her to the dwelling place of 
devils. A man in the village where she resides, who passes for a sorcerer, 
gives his body, without the least doubt on her part, to the devil. At forty 
years of age the menses cease. At this period her ideas become deranged, 
but in a manner imperceptible to strangers, and she suffers from cephalalgia. 
Forty-two years. Returning from a long excursion, she is fatigued, and lies 
down upon the earth to refresh herself Shortly after, she experiences in her 
head a motion and noise like that of a spinning wheel. She is frightened, 
but nevertheless resumes her course, and on the way, is raised from the earth, 
to the height of more than seven feet. Having reached her place of resi- 
dence, she can neither eat nor drink. She calls to mind the threat that had 
been made with reference to her, four years previously, and no longer doubts 
that she is bewitched. Many remedies are administered, and she makes pray- 
ers, performs devotions of nine days' duration, and also pilgrimages. She 
wears a stole, which had been presented her by a priest. But all in vain. 
The devil and his torments no longer leave her, and three years afterwards, 
she is brought to the Salpetriere. 

At the time of her arrival at the hospital she is extremely emaciated, her 
skin is sun-burnt, earthy, and hot ; the pulse it feeble and small, the head is 
bowed down, the face bloated, and the forehead wrinkled. The eye-brows, at 
times mingling with the folds of the forehead, are lost in the hair : the abdo- 
men is hard and voluminous, and the patient has her hand constantly upon it. 
She assures us that she has, in her uterus, an evil spirit, in the form of a ser- 
pent, which leaves her neither day nor night, although her organs of genera- 
tion are not like those of other women. She complains of a great degree of 
constriction about the throat, and experiences a necessity to walk about, and 
suffers much more acutely if prevented from doing so. She walks slowly, 
speaking in a low tone of her condition, which she deplores. She conceals 
herself when she eats and drinks, as well as when called to evacuate the blad- 
der and bowels, in order the better to persuade us that she is not a body, but 
merely a spectre and imaginary being. 



DEMONOMANIA. 24 1 

" The devil has taken from me my body, and I have no lono-er a human 
shape. There is nothing so dreadful as to appear to live and yet not to be of 
this world. I burn, sulphur exhales with my breath. I neither eat or drink 
because the -devil has no need either of food or drink. I feel nothino- and 
should I be placed in a terrestrial fire, I should not burn. I shall live mil- 
lions of years ; that which is upon the earth not being able to die. Were 
it not so, despair would have caused me, long since, to terminate my exist- 
ence." 

Nothing undeceives her, and she is abusive in her language to those who 
seem to doubt the truth of what she affirms. Those who contradict her, she 
calls sorcerers and demons. If they insist upon the correctness of their opin- 
ion respecting her, she becomes irritated, her eyes project, and are red and 
haggard. Look then, she says, at this beautiful figure ; is it that of a woman 
or a devil ? She strikes herself violently with her fist upon her chest. She 
pretends also, to be insensible, and to prove it, pinches her skin with all her 
might, and strikes her chest with a wooden shoe. I have myself pinched her, 
pricked her often with a pin, and transfixed the skin of her arm, without her 
testifying the least suffering. Still she manifested pain when not forewarned. 
This woman is tranquil, is not mischievous, and speaks rationally upon every 
other subject, when we can divert her thoughts. On pretext of deliverino- 
her out of the power of the devil, and unbewitching her, she was thrice mag- 
netized, but without my being able to witness any magnetic effect. 

H., fifty-one years of age, and a pedler by occupation, menstruated only 
after the age of twenty-four years. She is subject to a headache and colic 
pains, and is the mother of three children. At the age of thirty-six years, 
and during her last pregnancy, she was accustomed to read the Apocalypse, 
and books which treated of ghosts and wizards. She was often frightened by 
these readings. Her last confinement was laborious, and she afterwards had 
several fainting turns. From time to time, she seemed to see flames. When 
thirty-seven years old, she borrows some money to oblige a relative. The cre- 
ditor harasses and threatens her. Distressed by this debt, and while walking 
in the garden connected with her residence, the devil appears to her, proposes 
to her to sign a paper with blood drawn from the little finger of her left hand, 
and promises her the sum of money she owes. After a long debate, she 
writes out her renunciation of God, and her voluntary sacrifice to the devil. 
No sooner has she committed this act, than the earth trembles beneath her 
feet and around her. Her house also, is encompassed by a whirlwind, which 
shakes and injures its roof At this instant, the evil spirit disappears, carry- 
ing away with him her real body, leaving only a phantom. All her neighbors 
were the terrified witnesses of these phenomena. Her real body being with 
the devil, its image is tempted to throw itself into the water, and to strangle 
itself. The devil incites her to divers crimes. Feeling that she was devour- 
ed by the fires of hell, she threw herself into a pond, and suffers more since 
than before. She has no blood, and is absolutely insensible. I pierced 
through the skin of her arm with a pin, but she appeared to experience no 
pain in consequence of it. I shall remain upon the earth, says she, until wise 
men have discovered a means of obliging the devil to bring back to the earth 
my natural body. All that I say was taught me by the body which no longer 
exists, but which, before my misfortune, was upon the earth. 

This woman is very much emaciated, her skin very brown and sun-burnt. 
Grief and despair are depicted upon her countenance, which is wrinkled and 
contracted. She walks about quietly, knitting, and avoids her companions. 
She does not regard herself as sick, but groans about her miserable condition, 
which nothing can change. She is tranquil, supports opposition, and has a 
great desire to be relieved of her infirmity. Cherishing this hope, she has 
four times consented to be magnetized, without however, deriving the least 

31 



242 DEMONOMANIA. 

possible effect from the operation. With the expectation that her portrait 
would be carried to the archbishop, she places herself in a very proper atti- 
tude to have it taken. Such was the condition of this unfortunate woman for 
twelve years. During eleven of them, she performed laborious services, ful- 
filling her duties very" satisfactorily. For one year only, did age and wretch- 
edness compel her to enter the Salpetriere. 

L. is fifty seven years of age, a laundress, and has been very devout from 
infancy. Menstruation commences at the age of fifteen years. At the age 
of seventeen she is married, and becomes the mother of fifteen children. 
When forty-six years of age, she loses her husband and one of her children, 
which expires in her arms ; since which period, there have been anomalies 
with respect to menstruation. Near this time, she indulges in religious scru- 
ples ; accuses herself of having partaken of the sacrament unworthily ; takes 
an exaggerated view of religious exercises ; neglects her occupations ; and 
passes her time in the church. There is insomnia. She groans, and stands 
in fear of hell. Fifty-two years of age. Cessation of the menses. Her fears 
are converted into religious terror, and she believes herself to be in the power 
of the devil. Fifty-four years of age ; fever and delirium. She throws her- 
self from the window, and is sent to the Hotel-Dieu, from whence, after five 
months, she is transferred to the Salpetriere. Extreme emaciation, skin sun- 
burnt, earthy, and complexion sallow. Expression of countenance restless. 
The whole body is in a sort or vacillation and continual balancing. She is 
constantly walking about, seeking to do mischief; to strike, to kill. 

" For a million of years I have been the wife of the devil. I know that 
I am with him ; for he lodges with me, and ceases not to say to me, that he is 
the father of my children. I suffer from uterine pains. My body is a sac, 
made of the skin of the devil, and is full of toads, serpents, and other unclean 
beasts, which spring from devils. I have no occasion to eat (though she eats 
largely). All that is given me is poison. I should long since have been dead, 
were I not the devil. For more than twenty years I have had no alvine eva- 
cuation. I have committed every kind of crime ; have slain and robbed. 
The devil is continually telling me to slay, and even to strangle my children. 
In one minute, I commit more crimes than all rogues have committed in a 
hundred years. Hence I am not sorry to wear a strait waistcoat ; for without 
this precaution, I should be dangerous. In giving myself away to the devil, 
I have been constrained to devote my children to him. But in return, I have 
required the devil to bring low, him that sits on high ; to slay God, and the 
Viro-in. When I was accustomed to receive the sacrament, I treated with 
contempt the good God of the Church. I no longer believe in him ; it is no 
longer necessary for me to do so. It is no longer necessary to make confes- 
sion, the devil forbids." 

L. remains aside, avoids her companions, fears lest she.shall do them harm, 
talks to herself, sees the devil on every side, and often disputes with him. 
This uuhappy being presents an example of demonomania, complicated with 
dementia and fury. The strangest illusions and hallucinations maintain her 
delirium, and provoke acts of the blindest fury. 

S., forty-eight years of age, is devoured by two demons who have taken up 
their' abode in her haunches, and come forth through her ears. Devils have 
made several marks upon her person, and her heart is daily displaced. She 
shall never die, though the devil may tell her to go and drown herself She 
has seen the two devils by which she is possessed. They are cats ; one of 
which is yellow and white, and the other black. She puts tobacco, whie, and 
particularly grease, upon her head and in her ears, to exorcise the devil. She 
walks constantly with naked feet in fair and rainy weather, and while walking, 
picks Up whatever comes in her way. She mislays her clothing, eats largely, 
and the dejections are involuntary. She sleeps not, is filthy, emaciated, and 



DEMONO MANIA. 243 

her skin very much sun-burnt. There is no coherence, even in the system of 
ideas that constantly occupy her mind. She articulates sounds with the great- 
est difficulty. This is a striking case of demonomania, which has deo-enerated 
into dementia, complicated with paralysis. 

I may be censured for having multiplied cases. However, even in their 
abridgment, they have appeared to me to offer the more interest, as the first 
three furnish us an example of simple demonomania, and the two latter, that 
of this malady complicated with dementia ; the one attended with fury, the 
other with paralysis. Besides, the whole five present features which charac- 
terize demoniacal possession. I pass to the analysis and appreciation of the 
symptoms of this malady, compared with the signs of possession, pointed out 
by writers on demonology. Demonomania is sometimes epidemic. Like all 
nervous maladies, it propagates itself by a kind of moral contagion, and by 
the power of imitation. The mal des andous, which afflicted Holland, Bel- 
gium and Germany, in the fourteenth century, was a kind of demonomania. 
In 1552 or 54, there was at Rome an epidemic of the possessed, which affect- 
ed eighty-four persons. A franciscan monk exorcised them in vain. The 
devils accused the Jews. The major part of those possessed were Jewish wo- 
men who had been baptized. About the same period, in the monastery of 
Kerndrop in Germany, all the nuns were possessed. The devils designated 
the cook of the convent, who confessed that she was a sorceress, and was 
burnt, together with her mother. The neighboring villages were also infect- 
ed. The example of the possessed at Loudun, indicated most clearly, the 
power of the imagination and imitation. This epidemic having pervaded cer- 
tain neighboring cities, threatened the Cevennes and all Upper Languedoc ; 
when the prudent policy of a bishop checked the progress of the evil, by di- 
vesting it of whatever pertained to the marvelous, with which the imagination 
had furnished it. The convulsionists of St. Medard, deservedly figure among 
the victims of moral contagion. This happily, is the last scene of the kind 
that has afflicted our country. 

We have elsewhere seen, that delirium ordinarily takes the character of the 
ideas prevailing at the epoch when the insanity bursts forth. So demonoma- 
nia is most frequent when religious ideas occupy the mind, and are the sub- 
ject of all discussions, whether public or private, civil or political. The his- 
tory of Christianity, the irruption of the religion of Mahomet, and the esta- 
blishment of Lutheranism and Calvinism prove this. In our day, the delirium 
of many insane persons runs upon politics. Mental alienation is strikingly 
hereditary. Why should not demonomania be so also ? Should we be sur- 
prised, if writers on demonology tell us, that from generation to generation, 
the members of the same family were devoted to the devil, or were sorcerers? 

Very rarely were they accustomed to see cases of demoniacal possession, 
previous to the age of puberty. Although a father and mother might have 
devoted their children to the devil, before or soon after their birth, they were 
initiated or admitted to the assembly of witches only after the age of puberty. 
Before this period of life, there was neither mania nor melancholy. The age 
most favorable for possession is from forty to fifty years. Old persons are 
little exposed to it. Thus, all authors observe that old men are no better 
adapted to utter oracles than for sorcery. An enfeebled imagination no 
longer lends itself to these miserable illusions. The appellation of old sorce- 
ress, confirms this result of general observation. One of the influences of this 
old sorceress is shown by a dry, emaciated, wrinkled and decrepit exterior, in 
the case of demonomaniacs who, in consequence of the moral tortures which 
they experience, and the physical evils and privations they endure, grow old, 
long before the usual decay of nature. Women are more subject to this dis- 
ease than men. Pliny assures us, that women are to be preferred to men, in 
magic. Quintilian is of the same opinion. Saul goes to consult witches. 



244 DEMONOMANIA. 

Those are witches whom the Jewish records recommend us to guard against. 
They were priestesses, pythonissfe and sybils, who uttered oracles. Bodin 
maintains that at the most, we find but one sorcerer to fifty sorceresses. Paul 
Zacchias establishes a still greater difference. Woman is more decidedly ner- 
vous ; she is more dependent upon her imagination, more submissive to the 
effects of fear and fright, more accessible to religious notions, more given to 
the marvelous, more subject to melancholy than man. Having reached the 
critical period, forsaken by the world, and passing from ennui to sadness, wo- 
man sinks into lypemania, often into its religious form. If hysteria be blend- 
ed with it, the conflict of the senses with the religious principles, plunges her 
into demonomania, when mental weakness, ignorance and prejudices have, so 
to speak, ftishioned the mind in advance, for a similar disease. 

The melancholic temperament, as that most favorable for the production of 
lypemania, is that of the greater part of demonomaniacs. A nervous habit, 
an imagination easily excited, and a pusillanimous disposition, essentially pre- 
dispose to this disease. It would be difficult to point out the conditions of 
life most favorable to the development of lypemania. It embraces among its 
victims, sovereigns, legislators, philosophers, the learned ; but more particular- 
ly the ignorant; men, whose infancy has been spent in listening to the histo- 
ries of wizards, demons, ghosts, and all those influences that are calculated 
to keep the mind restless, tormented, and disposed to the strangest impressions 
of alarm and fear. (Mallebranche). A bad education, religious fanaticism, 
an ascetic life, false and exaggerated notions of divine justice, damnation and 
hell, are also causes, more or less remote, of this disease ; just as the perusal 
of romances disposes to erotic melancholy, and the reading of mystical books, 
or those relating to sorcery, to demonomania. For a long period, demonoma- 
nia has been scarcely observed, and attacks only the feeble-minded and credu- 
lous. Since the reign of Henry HI, Q^rodius remarks that sorcery has been 
the portion only of the ignorant and peasantry. Among more than twenty 
thousand insane persons who have passed under my observation, I have 
scarcely seen one among a thousand, stricken with this fatal disease. They 
are, almost invariably, persons belonging to the lowest class of society ; rarely 
men occupying rank in the world by their birth, education and fortune. 
There are besides, certain worthless knaves, who abuse the simplicity and ig- 
norance of the inhabitants of the country, by causing them to believe that they 
possess a diabolical power ; that they can destroy the virile power ; make 
children sick ; and throw a spell over the flocks. Certain phenomena imper- 
fectly observed, fortify the belief of these timid, simple and credulous people, 
and sorcery still maintains certain obscure and contemptible relics of its an- 
cient power. We still find in Germany, certain traces of this leprosy of the 
human mind, which, with this exception, is banished into the extreme north of 
Europe; and into the country of the Malaquais, Siamese, Indians, and other 
people enveloped in the thick darkness of ignorance. 

The individual and proximate causes of demonomania, are the same with 
those of lypemania; but this variety recognizes causes which may be regard- 
ed as specific. They are either physical or moral. A feeble mind, a vicious 
education, the reading of works on sorcery, magic, etc. ; false religious notions 
and prejudices, predispose to demonomania. An intense moral commotion, a 
fright, an unusual or threatening proposal or look, an exciting sermon, the 
force of imitation, suffice to produce an attack. Widowhood, the critical pe- 
riod, frictions upon the body, suppositories prepared from certain substances, 
drinks composed of enervating and narcotic substances ; such are the physi- 
cal causes of this malady. Gassendi tells us, that a provincial shepherd was 
accustomed to provide himself with a suppository of Stramonium when he re- 
tired at night, and on waking would relate all that he had seen at the witch- 
meeting. Certain sorcerers in order to gain access to these assemblages, were 



DEMONOMANIA. 245 

accustomed to anoint their bodies with fat, which had been prepared with irri- 
tating, or narcotic substances. These applications produce their effects in two 
ways : 1st, upon the imagination; by exciting and fixing it upon events, pro- 
mised and desired ; 2d, by irritating the brain, they provoked dreams, which 
were almost alwa3's predicated upon the ideas, desires or fears of the sleep- 
er. This mode of enchantment is very ancient, since the Greeks denominat- 
ed sorcerers and magicians cpuQi)«y.ld&g. They also gave them this name per- 
haps because the use of plants was connected with their enchantments. 

Demoniacal possession has often been caused by the look merely, of a sor- 
cerer. The influence of an amorous look upon a young person, the effects of a 
choleric or threatening expression upon a timid or prejudiced mind ; will they not 
account for the consequences of enchantment by the look ! without the neces- 
sity of having recourse to a supernatural and diabolical power ? The attack 
of demonomania bursts forth, in general, suddenly. Its invasion is prompt, its 
duration variable, and its cure doubtful. Demonomania terminates in demen- 
tia. Convulsions, marasmus, scurvy, phthisis or a slow fever, bring to a close 
the life of this unfortunate class of our fellow beings. Demonomaniacs are 
emaciated, their complexion is sallow and sun-burnt, their physiognomy indi- 
cates disquietude, the look is suspicious, and the features of the face shrunken. 
They do not sleep, eat little, and often secretly. They walk much, and suffer 
from constipation. They are fond of solitude, experience pains in the head, 
chest, abdomen and limbs, and accuse the devil of it. They feel an internal 
fire which consumes them, and believe that they are in the flames of hell which 
they alone perceived. Their breath seems to be on fire. With groans they 
lament their fate, but never weep. They strive to injure those who surround 
them, and suffer from a thousand hallucinations, and even fury. The possess- 
ed exhale a very strong odor, which betrays, say they, the presence of the 
devil. This phenomenon is not rare in nervous maladies, either because the 
breath has become fetid, or because the transpiration has acquired an odor 
very much increased by the morbid character of the fluids. Does the fetor of 
the breath announce a threatening attack of convulsions, mania or hysteria? 
Women in a state of demonomania, experience a thousand hysterical symp- 
toms. They believe that they are transported to the midnight assemblies of 
wizards, where they are witnesses of the strangest extravagances. They have 
intimate communications with the devil or his subordinates ; after which, a 
collapse bringing an end to the attack, they find themselves again in the same 
place, from whence they believed they had been taken. Who does not see in 
this, the last stage of an attack of hysteria? Amidst the obscenities of these 
meetings, which we shall be cautious about describing, — who does not recog- 
nize the turpitude of an imagination, polluted by the vilest, most obscene and 
disgusting debauchery ? who does not recognize a description of the most ex- 
travagant, shameful and ribald dreams? The frequent ecstasies which take 
place in nervous affections, partake of a sublime and contemplative character, if, 
during its waking hours, the soul is elevated to the contemplation of noble and 
divine objects. They are erotic, if the mind and heart lull themselves in reve- 
ries of love. They are obscene, if, when awake, one indulges in lascivious 
thoughts, and if the uterus, irritated and excited, gives place to illusions, 
which are regarded as diabolical practices. 

The cases reported in the different articles of this work, establish the cor- 
rectness of this view. Besides, they strikingly resemble the case of Angele 
de Soligny, reported by Martin Del-Rio. Did not this female present all the 
features of nymphomania, provoked by widowhood, and a contemplative life 
carried to an extreme, and combated by religious principles? In the descrip- 
tion of the nightly meetings of the witches, are united all those circumstances 
which are proper to excite the imagination. Assemblies, devoted to mysteri- 
ous rites, have at all times been holden during the night. Night is most fa- 



246 DEMONOMANIA. 

vorable to illusions and to fear. It presides over dreams. An uninhabited 
island, a rugged rock, a cavern surrounded by an ancient forest, an old and 
abandoned chateau, a cemetery, etc., such were the places of rendezvous. The 
adoration of the he-goat, dates back to the earliest period. It appertains to 
an ancient religious custom of the Egyptians, who offered, in Mendes, an infa- 
mous worship to the he-goat Hazazel. The ancients were in the habit of 
joining to prayers and invocations, the preparation of certain plants, and the 
immolation of certain animals, devoted to the infernal powers. Children also, 
were sacrificed. From the time o^the introduction of Christianity, sorcery 
allied itself to those notions of spirituality that prevailed. It borrowed from 
the christian worship, crosses, prayers and consecrated wafers ; and profaned 
these sacred objects in a manner most revolting, in order to avenge the devil 
for his defeat. The sorcerers of Ireland, always recite the Ave Maria in their 
practices of sorcery. In Livonia, the grand talisman against sorcery consists 
in the following words ; Two eyes have regarded thee ; three others can cast 
upon thee a favorable look, in the name of the Father, So7i and Holy Ghost. 

Like all lypemaniacs, demonomaniacs suffer from hallucinations and illusions 
of the senses. Some think that they are the devil, others persuade themselves 
that they have the devil within them, who pinches, bites, rends and burns 
them. Some hear him speak, and his voice proceeds from the stomach, bow- 
els or uterus. They converse with him, the devil recommending to them the 
commission of crimes, murders, acts of incendiarism and suicide. He pro- 
vokes them to the most disgusting obscenities, and to blasphemies the most 
impious. He threatens and even strikes them, if they do not obey his orders. 
Many, who were retained in prison on account of their possession, assured 
those about them, that the devil had come thither to find them. Do we not 
see maniacs and melancholies, who converse with imaginary beings, who, they 
persuade themselves, are at their side, and were introduced by the chimney 
and window? The illusions of sight and touch, are here the same as with 
demonomaniacs. Some of the possessed or sorcerers, as a conveyance to 
their nightly assemblages, bestrode a broom. Others were mounted upon a 
he-goat, an ass, dog, etc. The latter, anointed the body with an ointment. 
The former had need only of their imagination. All, without passing up the 
chimney, leaving their habitation, or even getting out of bed, reached the 
place of meeting, where they saw the devil ; now, in the shape of a he-goat, 
a satyr or black cat; now, in that of a man, either black or white. Such are 
the disgustiiiff reveries that have given rise to the belief in the existence of 
incubi and succubi. Some women, mostly hysterical, have seen the devil un- 
der the form of a young man, handsome, and well made. Doubtless libertines, 
abusincr the weakness of some women, have borrowed from the devil his form 
and power. I once had in charge a maniac, who every night believed that he 
went to bed with his mistresses, and was accustomed to converse with them, 
assuming a different tone with each, and having reference to their respective 
dispositions and humor. There are many erotic lypemaniacs, who are con- 
vinced that they have had intimate relations with men, to whom they have 
scarcely addressed a word, but by whom their imagination has been taken. 

Mad'lle de S., aged thirty-one years, of medium size, having black hair and 
eyebrows, a slender habit of body, and nervous temperament, together with a 
disposition disposed to melancholy, in company with her mother attends the 
botanical course of a celebrated professor. After a few lectures she persuades 
herself that she is pregnant by the professor, who is advanced in life, and to 
whom she has never spoken. Nothing dissuades her from this belief She 
becomes much emaciated, loses her appetite, and is invincibly opposed to lis- 
tening again to him who has made her a mother. The menses are suppressed, 
which is a new proof of pregnancy. The counsels of a tender and beloved 
mother, physicians and medicines, are all repulsed with obstinacy. She spends 



UEMONOMANIA. 247 

the eighth month in preparing child-bed linen. The ninth and tenth month 
pass without confinement. It does not take place, says the patient, because 
there are not colics and necessary pains. She stands much with naked feet, 
in order to provoke pains. She hears the father of her child, who exhorts her 
to patience, and encourages her to support the throes favorable to parturition. 
She sometimes utters cries, which are common to women at this period. In 
other respects, she is perfectly rational. I know well that I am like an insane 
person, she sometimes says, but it is certain that I am pregnant. She is com- 
mitted to my care after suffering from this malady for eighteen months. She 
is very much emaciated and feeble, pulse frequent and small, skin dry and hot. 
She is sad, neither speaking nor moving ; wishing neither to sit down during 
the day, nor to retire during the night. She also refuses all nourishment. I 
was enabled to overcome her unwillingness to take food, by effusions of cold 
water. But nothing triumphed over the convictions of this patient, who, some 
months after, went into the country to terminate her earthly pilgrimage. 

The continual muttering of some of the possessed, has given rise to the 
belief that these unfortunate beings conversed with the devil in an unintelli- 
gible maimer. We find this symptom existing in a great many melancholies, 
especially among those who have fallen into a state of dementia, and who stam- 
mer, in a low voice, words having no connection. The possessed, like all me- 
lancholies, beset by their own ideas, neglected their relatives, friends and in- 
terests. They were miserable and unfortunate ; never improving, in a pecu- 
niary respect, the condition of their family. They could no more do it, than 
deliver themselves from the demons and judges who were going to burn them. 
Improvidence, and incapacity for every kind of occupation, are the character- 
istics, not only of lypemania, but also of most of those passions which are 
intimately connected with it. The possessed were very obstinate in their be- 
lief, rarely betraying their adherence to it. Notwithstanding the severest pun- 
ishments, in spite of the rack, which was most inhuman, the greater part re- 
mained attached to their notions, and obstinately refused to renounce their 
compact. The demon gave them this power and obstinacy. They were aban- 
doned of God, who detested their abominations. This infatuation is charac- 
teristic of melancholy. Neither reasoning, privations, nor pain, can convince 
the lypemaniac. The stronger the efforts made to persuade him, the greater 
is his resistance, and the more powerfully does he \vithstand. Suspicion, 
fear and self-love fortify his convictions, which punishments only increase. 
I had in charge a young man who, deceived by an exaggerated notion of 
honor, refused all nourishment. After having exhausted all known means 
to overcome this resolution, I applied with much preparation, red hot irons 
upon different parts of his body, without overcoming his purpose. A surprise 
succeeds better. What can man not support, when sustained by a strongly 
excited imagination ! The children of Sparta, lacerated by whips upon the 
altar of Diana, expired without uttering a complaint. A child at Lacedemon, 
having stolen a fox, concealed him beneath his tunic, and permitted his abdo- 
men to be mangled by the teeth and claws of this animal, without manifest- 
ing the least pain, through fear of being discovered. To how great an ex- 
tent does insensibility proceed in hysteria and convulsions ! 

The princess B., twenty seven-years of age, of a nervous temperament, a 
very lively imagination, a gay and mild disposition, had received a very excel- 
lent and liberal education, too strictly intellectual for a woman. Married 
when very young, she meets with great domestic trials, which repress her na- 
tural gayety, and render her melancholic. Missionaries go to St. Petersburg, 
and obtain permission to preach. Their sermons produce a strong impression 
upon the minds of the great ladies of that country. The imagination of the 
princess is not the last to become excited. See her now, an enthusiast, and 
uncertain whether she shall abandon the prevailing mode of worship. The 



248 DEMONOMANIA. 

sovereign, at first, expresses his dissatisfaction, and afterwards sends back the 
missionaries. Every one fears to incur the displeasure of a sovereign whom 
he loves. The princess, enfeebled by her sorrow, is easily subjugated by reli- 
gious terrors, and the apprehension of a persecution. She becomes a lypema- 
niac, accuses herself of having committed crimes, and expresses a dread of 
being exposed to suffer martyrdom. Her aberration of mind increases, and 
one day, either to punish herself, or to test her courage, she places the middle 
finger of the right hand in the flame of a wax candle, and allows it to remain 
there so long, that it was necessary to remove its three phalanges, so deep had 
been the burn. At the expiration of four years, alternating between agitation 
and fury, composure and sadness, excitement and depression, the princess 
is brought to Paris and committed to my care. She was in a state of demen- 
tia complicated with paralysis, and attended with a disposition to transports of 
passion, and to strike when opposed. What could I do to overcome a disease 
like this ? Her physical condition is improved, but reason was forever lost. 

Punishments, invented by the most refined cruelty, could not draw tears 
from the eyes of the possessed when put to the torture. The demon, said 
they, dried up their source. Almost all lypemaniacs experience a desire to 
weep, without the ability to shed a tear, by whatever effort they may make. 
The sleep, into which some fell during the tortures of the rack, was the 
strongest proof of possession. They did not then know, that excessive pain 
produces an uncontrollable desire to sleep. They were accustomed to bind 
the limbs of the possessed before casting them into the water ; and if they 
then swam upon it, they were regarded as possessed. Some hysterical women 
could not submerge themselves in the water, and floated when plunged into 
it. Those in favor of the punishment of the possessed, recommended that 
these unfortunates be interrogated, immediately after their arrest ; because, so 
soon as they are taken, they think that they are forsaken by the devil, and 
confess every thing ; whilst, if we allow them time to reflect, the devil comes 
and gives them instruction, (Del-Rio, Bodin, de I'Ancre). Who can forget 
the effects of a lively and vigorous impression, which always suspends the de- 
lirium for some moments, only to resume its power, so soon as the first effect 
of this moral commotion has ceased 1 Upon this phenomenon, reposes the 
most important therapeutic precept, for the treatment of the insane. Some of 
the possessed, unable to support the miseries they experienced, and incapable 
of resisting the varied solicitations which the devil made to them, pursued by 
remorse for crimes which they had committed, or with which they charged 
themselves, tormented by their thoughts, and tortured in a thousand ways, 
solicited death, prayed that the time of punishment might be hastened, threat- 
ened to destroy themselves, and marched gayly to the scaffold. Is not this 
symptom common to many melancholies, who prefer death a thousand times, 
to the disquietudes and anguish that torment, and the moral suffering which 
overwhelms them ; an agony more intolerable than all the physical pains ima- 
ginable ? Others on the contrary, persuaded that they could not die, (the 
devil having given them an assurance of it), went to their punishment with 
composure and tranquillity ; sometimes with disdain. This sense of security, 
which depended upon an illusion, a deceitful hope, was regarded as an incon- 
testable proof of the pre.sence of a demon. I have reported the cases of 
lypemaniacs, who were fully convinced that they could not die, and who were 
accustomed to enquire of me, what they should do, when left alone upon the 
earth. Convulsions existed in all times, because they depended upon the 
state of the organism, as well as the imagination. They complicate all the 
forms of mental alienation. Priestesses, sybils and pythonissae fell into con- 
vulsions when the prophetic spirit took possession of them. The possessed 
were seized with convulsions when the delirium was very intense, and some 
became maniacs, enraged, and died. This termination, which is not rare in 



D E M O N O M A N I A . 249 

convulsive diseases, was regarded as the last effort of the devil, constrained to 
leave the body of the possessed person ; and knaves took advantage of it, the 
better to deceive the ignorant. In reading the histories, reported by writers 
on demonology, as preserved in the accounts of the trials of the possessed, we 
learn that those contortions, convulsions, and great muscular contractions, 
referred to as efforts of the devil, are nothing more than those nervous symp- 
toms, to which hysterical persons, hypochondriacs and epileptics, are all ex- 
posed. These convulsions did not deceive Pigrai when appointed to pro- 
nounce upon fourteen unfortunate persons, who had been condemned to the 
flames. He decided that hellebore should be given them. They did not 
triumph over the learned men who saw them at St. Medard, nor over the 
magistrate who caused them to cease at his will ; notwithstanding the mur- 
mur of certain rogues, who desired longer to abuse the public credulity. 
From what precedes, we conclude : 

1. That demonomania is a variety of religious melancholy. 

2. That it recognizes as its remote cause, ignorance, prejudices and the 
feebleness and pusillanimity of the human mind. 

3. That disquietude, fear and dread provoke it. 

4. That the delirium, determinations and actions of demonomaniacs, de- 
pend upon, as their principal cause, false notions of religion, and a frightful 
depravation of morals. 

5. That this disease has become more rare, since religious knowledge, a 
better education, and more general instruction, have more uniformly enlight- 
ened all classes of society. 

We must signalize as one of the varieties of demonomania, that state in 
which some insane persons, stricken by the terrors of hell, believe that they 
are damned. These are persons whose minds are feeble, timid and fearful ; 
whose hearts are upright and pure ; whose convictions are profound, and who 
think that they have committed errors and crimes whose chastisement they 
cannot shun. Such are in a state of despair. They are not, like demono- 
maniacs, actually in the power of the devil. They neither see nor feel the 
sulphureous flames which devour them. Still they dread damnation, and are 
convinced that their career will terminate in hell. They impose upon them- 
selves mortifications more or less extreme, as well as singular, in order to 
avoid their destiny. The history of all religions presents the cases of men 
who, fearful of the future, submit both their bodies and minds to the most 
cruel and inconceivable tortures ; now, to secure the favors of heaven ; and 
now, to disarm the celestial anger. A pusillanimous disposition, exaggera- 
tion, ignorance of the true principles of religion ; the reading of books calcu- 
lated to enslave the mind, the critical period, masturbation, and reverses of 
fortune ; are the most frequent causes of this variety, which, in our day, is not 
so rare as demonomania, and does not spare, like it, the higher ranks of so- 
ciety. Demonomania furnishes the most striking proof of the strange oppo- 
sition which exists between the ideas and determinations. The impulse to 
murder and suicide is very much to be feared among individuals, who stand 
in fear of eternal damnation. Sauvages, Forestus and Pinel, mention several 
cases of them. It is neither the spleen, nor disgust of life, which urges them 
on to suicide. It is neither the fright, which, depriving rnan of the faculty of 
reasoning, precipitates him upon the evil which he most fears. How happens 
it, said I to a young man, that you fear being damned, and yet wish, by tak- 
ing your own life, to hasten on the period of eternal punishment, the very 
thought of which fills you with despair 1 This simple mode of reasoning he 
could not comprehend. Fear is a sentiment which is surmounted by a still 
stronger one. Persons who fear eternal damnation, are indescribably misera- 
ble. Solely occupied by their sufferings and actual torments, imagination 
represents this state of anguish as the greatest of evils ; as greater than death 
32 



250 DEMONOMANIA. 

itself. The evils which they dread, but do not feel, necessarily produce less 
effect upon them, than those which they endure. Future ills can be but ima- 
ginary, whilst actual ones are realities. Their intolerable position is frightful, 
and must be changed. Not having the courage to suffer, how should they 
have to hope ? All is despair. This state of things must cease, cost what it 
may. The surest means of effecting it, is to cease to live. The resolution is 
taken, — reason wanders, — the future — and the punishments of hell , vanish. De- 
lirium and despair direct the steel of the monomaniac, who commits self-murder. 

Of all insane persons lypemaniacs are the most cruel. Not only do these 
wretched beings attempt their own destruction ; but direct their deadly blows 
at the persons of their friends, relatives and children. A miserable being, 
after listening to a sermon, believing himself damned, goes home and destroys 
his children to preserve them from the same dreadful doom (Pinel). A young 
woman experiences certain domestic trials. She immediately persuades her- 
self that she is lost, and for more than six months is haunted with the desire 
to destroy her children, to preserve them from the sufferings of a future state. 
When suffering from this frightful form of insanity, and, yielding to their 
blind fury, these wretched beings have executed their horrible purposes, they 
are never restored. Such is my experience. We are of the opinion that re- 
turnincr reason, bringing with it but too just reproaches, induces moral suffer- 
ing, and gives rise to the most poignant regrets, which are shortly succeeded 
by the same torments and delirium. The treatment of demonomania is the 
same with that of lypemania, or melancholy with delirium. The pharmaceu- 
tic treatment, as well as the regimen, depend upon the knowledge of its causes. 
Albrecht tells us, that he cured a robust man, who for some years was regard- 
ed as possessed, by causing him to take wine, impregnated with emetic quali- 
ties, during alternate periods of fourteen days ; at the fourth period his patient 
was cured.* 

The moral means do not differ from those which are adapted to lypemania 
in general. The assistance of ministers of religion has rarely been followed 
with permanent success. A lady believed herself damned, and had recourse 
to several priests. A prelate, as respectable by his age as his virtues, went 
to her residence arrayed in his pontifical robes, received her confession, and 
lavished upon her religious consolations. The patient recovered her reason 
perfectly for a few hours ; but on the following day, she relapsed into a state 
worse than her former one had been. However, I by no means think that 
such aid ought to be neglected. The consolations of religion, the presence 
and encouragements of a minister of the altar, by calling into exercise a de- 
gree of confidence on the part of the patient, may cause hope to spring up in 
his breast, and prove the commencement of a cure. We find several exam- 
ples of cures among authors. Zacutus relates, that he restored to health a 
demonomaniac, by introducing into his chamber during the night, an indivi- 
dual in the guise of an angel, who announced to the patient that God had 
pardoned him. We can imagine, that success might attend the like efforts 
in similar cases. If the disease is not of long standing, if it is not compli- 
cated with organic lesions, with paralysis or scurvy, we may hope for a degree 
of success. Reil suggests a great number of means, but reduces all to this 
general principle : to make a vivid impre.ssion upon the imagination of the 
insane, in order to subjugate it, and afterwards to gain possession of their 
confidence and mind ; or to combat a passion by a passion. To do this, an 
observing mind is necessary, and a thorough acquaintance with the manage- 
ment of the understanding and passions of men. 

Connected with demonomania as a sub-variety, is Zoanthropy ; a deplorable 
aberration of the mind, which perverts the instinct even, and persuades the 

* Philosopical Decade, year iv. 



DEMONOMANIA. 251 

lypemaniac that he is changed into a brute. This strange form of insanity 
has been observed from the highest antiquity ; and was connected with the 
worship of the ancient pagans who sacrificed animals to their gods. Lycan- 
thropy was described by /Etius and the Arabians. It has been known since 
the fifteenth century, and they have given in France, to those afflicted with 
this disease, the appellation of wolf-men. These wretched beings fly from 
their fellow men, live in the woods, church-yards and ancient ruins, and wan- 
der, howling, about the country at night. They permit their beard and nails 
to grow, and thus become confirmed in their deplorable conviction, by seeing 
themselves covered with long hair, and armed with claws. Impelled by ne- 
cessity or a cruel ferocity, they fall upon children, tear, slay and devour them. 
Roulet, at the end of the sixteenth century, was arrested as a wolf-man, and 
confessed, that with his brother and cousin, after having rubbed the body with 
an ointment, they were changed into wolves, and that they then ran about the 
fields, and devoured children. Justice, more enlightened than in the pre- 
ceding ages of the world, sent these unfortunate men to a hospital for the 
insane. 

There have been lycanthropes who believed that they were transformed into 
dogs. These are called cynanthropes. A distinguished lord of the court of 
Louis XIV. experienced, at times, a disposition to bark, and was accustomed 
to put his head out of the window to satisfy this desire. Don Calmet tells us 
that in a convent of Germany, the nuns believed that they were changed into 
cats, and that, at a certain hour of the day, they were accustomed to run all 
about the convent, striving to outdo each other in mewing. We find, even in 
our days, insane persons who, no longer believing in the power of the devil 
over matter, still believe in destiny ; and persuade themselves that it imposes 
upon them all the pains they suffer ; that they are objects of horror, and ought 
to be removed from the world. This unfortunate caprice manifests itself in 
the country. We have at Charenton a young man from the mountains of 
Limousin, of a bilious-sanguine temperament, slender and emaciated in his 
habit, with black hair and eyes, and a pale complexion, who has a dracq 
in his abdomen. The dracq, or destiny, sometimes enters his head, tortures 
him in a thousand ways during the day, and particularly in the night, ad- 
dresses and threatens him. If I ask this unfortunate young man what this 
dracq may be, " I know nothing about it," he replies, " but it is a destiny 
that has been imposed upon me, and every thing has been done to deliver me 
from it, but without success." Other lypemaniacs are convinced that they 
have no head, that they have one of glass or of a bird, that an enormous ex- 
crescence depends from the nose, and that their body is of butter, their limbs of 
wax or of glass. We must also speak again of that singular perversion, which 
persuades a young woman at Charenton that she no longer has a body, and 
who is constantly going about, like a person who has lost his way, seeking 
for her body. She calls upon us for it, during a visit, and repeats incessantly, 
" I have no longer a body, — what will become of me! give me my body." 
Hippocrates understood the cause of the disease of the Scythians, which 
sometimes appears in our days, from different influences. 

Mad'e M., a widow, experienced, after the death of her husband, very great 
trials, together with the loss of her fortune. She has an attack of mania, 
makes attempts to commit suicide, and is sent to the Salpetriere. She was 
small in stature, very much emaciated, much agitated, constantly talking, as- 
suring us and repeating with transports of emotion, that she was not a woman, 
but a man. If any one, in speaking to her, addresses her with the appellation 
of Madame, she immediately becomes more agitated, utters abusive language, 
or gives herself up to acts of violence. M. Pussin, then inspector in the di- 
rection of that department of the hospital devoted to insane women, engaged 
with M. Pinel to procure the dress of a man for this female. She attired 



25-2 DEMONOMANIA. 

herself in it with transports of joy, and walked about among her companions 
with a sort of ostentation. She was more composed and tranquil, and talked 
much less, but was excited to fury, if not addressed by the title of Monsieur 
instead of Madame. Her strength gradually gave way, and she entered the 
infirmary in the month of November, 1802, having a copious diarrhoea, and 
being exceedingly weak. She rejected baths, ptisans, and the potions that 
were prescribed for her. At length, she became unwilling to take any thing, 
and died, aged sixty-eight years, her delirium remaining unchanged to tlie 
last days of her life. 

At the post-mortem examination, I found the external vessels of the crani- 
um gorged with blood. The cerebral substance presented nothing remarka- 
ble, except rmmerous bloody points when it was divided by slices. The late- 
ral ventricles contained each about two ounces of serum. The mucous mem- 
brane of the stomach, in its small curvature, presented an ulcer of about four 
inches in circumference, its surface being covered with granulations, and of 
a crrayish aspect. Near the pylorus, there vvas a species of polypus, extremely 
soft, and large at its base, projecting about an inch, and having a brown color. 
Traces of inflammation were noticed upon the mucous membrane of the 
stomach, cecum, colon and rectum ; and at some points this membrane was 
destroyed. The gall bladder contained bile of a deep green color, inspissated, 
and mingled with small concretions. 

I had in charge, many years since, a man twenty-six years of age, of a 
noble stature, large size, and genteel figure, who, in his earliest youth, was 
very fond of dressing himself in women's clothes. Admitted into the highest 
circles, if a comedy was performed, he always chose the part of a female. 
At length, in consequence of a trifling opposition, he persuaded himself that 
he was a woman, and sought to convince every body of it, even the members 
of his family. Several times did he, while at home, divest himself of all his 
clothes, array himself with the head-dress and costume of a nymph, and, thus 
attired, wished to walk abroad in the streets. When committed to my care, 
aside from this notion, he was not irrational. He was however, constantly 
occupied in curling his hair, in admiring himself in the glass, and with his 
dressing gowns, used every effort to render his costume as similar as possible 
to that of a woman. He was accustomed, also, to imitate their step when 
walking. One day while walking with him in the garden, I raised the lappet 
of his riding coat, which he had carefully arranged, when immediately he 
takes one step backward, and treats me in an impertinent and lewd manner. 
No reasoning, attention nor regimen, were successful in restoring this unfor- 
tunate man to the use of his reason. 



SUICIDE. 



Origin of term. — Ancient philosophers not agreed with respect to the appreciation of this 
act. — Legislation with respect to it. — A variety of circumstances lead man to termi- 
nate his existence. — The impulse of lofly sentiments, — false popular views, — national 
usages, — passions, — febrile delirium and mania, — hypochondria and lypemania. — Sui- 
cide provoked BY THE PASSIONS. — When strongly excited, always produce disturbance 
in the organism or understanding of man. — Acute and chronic. — Examples of acute sui- 
cide, with remarks. — Chronic suicide. — Remarkable examples. — Suicide preceded by 
HOMICIDE. — Mental condition previous to, and after an act of homicide described. — 
Form which precedes homicide, usually acute, sometimes chronic. — Examples, and 
development of important principles. — Reciprocal suicide. — Examples. — Disposition 
sometimes feigned. — Examples and treatment. — Climates, seasons, age and sex, con- 
sidered AS causes of suicide. — Climates one of the proximate causes, but less active 
than morals, civilization, etc. — Table of quarterly admissions at the Salpetriere of those 
who had attempted suicide. — Most frequent during the warm seasons. — Hereditary. — 
Examples. — Most frequent when. — See table. — Children sometimes victims of suicide, 
from vicious education. — Old age rarely exposed to suicide. — Examples. — Less fre- 
quent among women than men. — Data establishing proportion of suicides between 
men and women. — Exceptions. — Sometimes epidemic. — Cause. — Preventive. — The 
reading of immoral and licentious books tends to suicide. — Description of chronic 
suicide only given. — Attempts usually voluntary. — Often great insensibility. — Exam- 
ples. — Instruments which suicides employ. — Great precaution used by some, to render 
their attempts eifective. — Several cases with treatment. — Vanity, and a spirit of re- 
venge sometimes manifested in this act. — Illustrations. — Various considerations pre- 
vent those who desire death, from the commission of suicide. — Case illustrative. — A 
frightful perseverance manifested in some cases. — Suicide is acute or chronic ; contiuned 
or intermittent. — Examples. — Pathological lesions observed among suicides. — 
Opinions of Gall, Home, Recamier, Loder and others. — Post-mortem examinations. — 
Note from 31. Leuret. — Query respecting the influence of the organs of digestion in 
the production of suicide. — Treatment of suicide : means of preventing it. — Moral 
influences, with examples. — A specific treatment recommended by some. — Bleeding. 
— Tonic. — Bark in combination with a narcotic or sedative agent. — Cold bath. — Copi- 
ous draughts of cold water and an issue over the liver. — Abundant corporeal and 
pleasant mental exercises. — {Farther remarks on treatment.) — Constant watchfulness 
on the part of those who have the charge of persons sufliering from a suicidal propen- 
sity, indispensable. — Restraining apparatus not to be relied upon. — Should sleep in 
public halls under the constant watch of an attendant. — {Remarks on.) — Success of 
this measure at the Salpetriere. — Mode of dissipating a repugnance to food in the early 



254 SUICIDE. 

stages of insanity. — Fear sometimes employed as a restraining agent. — Is suicide a 
criminal act ? Can it be prevented or lessened by legislation ? Remarks, etc., on the 
writings of Doct. Burrows. — Suicides greatly increased within the last half century. — 
Relative proportion of suicides in Paris and Berlin compared. — Proportion of men and 
women. — Proportion of either sex who have availed themselves of certain modes of 
committing suicide. — Researches of M. Guerry on suicide. — Summer produces more 
suicides than autumn. — Greatest number committed between the hours of four and six, 
and least, between two and four, in the morning. 

In no language, was there formerly a term to express that act, by which 
man terminates his existence. The term which was wanting to express an 
act which has unhappily become so frequent, was originated, during the last 
century, by the celebrated Desfontaines. It is suicidum, autochiria, melancolia 
anglica of Sauvages, suicide of Pinel. Morals and religious beliefs, as well as 
the laws, have singularly contributed to modify the opinion of people respect- 
ing self-murder, and to render it more or less frequent. The ancient philoso- 
phers were not agreed with respect to the appreciation of this act. Some, 
with Demetrius and Zeno at their head, have not only approved of suicide, 
but justified it by their example. Certain others, as Plato and Cicero, have 
entertained doubtful opinions, while the greater number, with Pythagoras and 
Socrates, condemn it. Legislation also, has varied among different people, 
and even in the same country. There, suicide is authorized by law : here, it 
is tolerated only under certain determinate circumstances : elsewhere, it is 
condemned as a crime. All the laws of modern and civilized Europe, and 
even the Coran, condemn and brand with infamy, the act of self-murder. 
However, a general opinion, which regards suicide, either as a matter of indif- 
ference, or as the effect of disease or delirium, seems to have prevailed in our 
days, though contrary to the civil and religious codes. It does not belong to 
my subject to treat of suicide in its legal relations, nor, consequently, of its 
criminality. I must limit myself to showing it to be one of the most impor- 
tant subjects of clinical medicine. Self-murder takes place under circum- 
stances so opposite, and is determined by motives so diverse, that it cannot be 
limited to any single denomination. However varied may be the motives and 
circumstances, which cause men to expose their lives, and to brave death, 
they almost always exalt the imagination, either on account of a good, more 
precious than life, or an evil more formidable than death. 

Before tracing the history of suicide, it may be well perhaps, to point out 
the principal circumstances which lead man to terminate his own existence. 
From these preliminary considerations, Ave will pass to an exposition of the 
symptoms, to an enquiry into the causes, and to the post-mortem examination 
of bodies. We will finally close, with some general views respecting the 
means proper to prevent suicide, and to combat the fatal impulse which urges 
man to the commission of self-murder. Man destroys himself, or exposes his 
life to certain destruction, under the impulse of the loftiest sentiments. The 
act is then worthy of admiration, and excludes all blame. The victims of 
false, but popular views ; of barbarous, but national usages ; not only are indi- 
viduals, but whole sects, doomed to a voluntary death. All the passions have 
their seasons of fury. In their excesses, there is nothing that they do not sa- 
crifice ; and man, while a prey to a passion, spares not his own life. In febrile 
delirium and mania, more lives are taken than is usually supposed. Hypo- 
chondria and lypemania are most frequently the true cause of that abhorrence 
and utter weariness of life, which so often give birth to that form of suicide, 
which we call voluntary. He who wishes to terminate his existence, moved 
by diverse motives, does not always lay violent hands upon himself, but be- 
comes a homicide. It is not unusual for two individuals, led away, either by 



SUICIDE. 255 

blind passion, or by wretchedness, to resolve to die, and reciprocally to take 
each other's life. 

Finally, suicide is sometimes feigned. From what precedes, we already 
perceive, that suicide is, with respect to our knowledge, only a phenomenon, 
consecutive to a great number of diverse causes ; that it presents itself under 
very different characters ; and that this phenomenon is not exclusively con- 
fined to any one malady. It is in consequence of having made suicide a 
malady sui generis, that they have established general propositions, which ex- 
perience disproves. He is not the homicide of himself, who, listening to the 
dictates of noble and generous sentiments, places himself in certain peril, 
exposes himself to inevitable death, and makes a voluntary sacrifice of life in 
obedience to the laws, and to guard the faith, plighted for the salvation of his 
country. Such were the Decii, who sought death in the camp of the enemy, 
to fulfil an oracle, which, at this price, had furnished victory to the Athenians. 
Such also, was Curtius, who precipitated himself armed, into an abyss, to as- 
sure victory to the Romans. Assas was another, who hesitated not to sacrifice 
his life to save the regiment of Auvergne, which would have been surprised, 
had it not been for the heroic devotion of this officer. The generous inhabi- 
tants of Calais and Rouen, were of this number ; who made an oftering of 
their lives, to save their fellow citizens who were ready to perish by the sword 
of the enemy, or by famine. Were Socrates and Regulus self-murderers ; 
the one, for having refused to avoid the execution of the laws which condemn- 
ed him to death ; the other, for being unwilling to forfeit his word? Shall 
we denominate suicides, those wretched beings who, victims to religious be- 
liefs, and the usages of their country, think, that by devoting themselves to 
death, they perform a duty, and an act at once memorable, and worthy of re- 
compense? This hope, embraced with ardor, has resulted in the sacrifice of 
life, not only on the part of a few individuals, but of colonies, and entire na- 
tions. Such were the Thracians, Germans and Arabians ; and such, at this 
day, are the Indians. 

The Gymnosophists, living in forests, learned to despise life. Meditating 
constantly upon death, they came to regard it as the supreme good. Diseases, 
infirmities, and old age, were regarded among them as an opprobrium, and 
the deepest disgrace was attached to a natural death. Thus, so soon as they 
were sick, old or infirm, they threw themselves upon the funeral pile. In the 
capital of the island of Ceos, the country of Simonides, old people were never 
seen. The usage of society called for their sacrifice, and the laws permitted 
those who had arrived at the age of sixty years, and were no longer capable 
of serving the republic, to commit the act of self-murder. It was a disgrace, 
to live for one's-self only. He who was to die, assembled his relatives, and 
after being crowned with flowers, as on a feast day, took a cup of the decoc- 
tion of the poppy, or of hemlock. The ancient inhabitants of the Canary 
islands, in order to honor their gods, were accustomed to throw themselves 
into an abyss, hoping to enjoy the felicity which was promised to a death so 
imposing. The Japanese drown themselves, the better to celebrate the divini- 
ty Amidas ; or shut themselves up in a tomb, walled on all sides, leaving only 
a small opening for the passage of air. Buried while living, they call without 
ceasing, Amidas, Amidas, until they die from hunger and exhaustion. The 
Gauls were accustomed to betake themselves to the other world, in order to 
close up their affairs. They lent money, on condition that it should be re- 
paid in the other world. They were accustomed to throw themselves upon 
the funeral pile of their relatives and friends, to indicate their extreme reluc- 
tance at parting with them. The widow of Malabar, mounts the funeral pile 
which is to consume the remains of her husband, in obedience to an ancient 
custom ; unwilling to survive, to meet the disgrace which she encounters, in 



256 SUICIDE. 

not sacrificing herself to his manes. The feast of the Ticonal never takes 
place in Bengal, without being the occasion of numerous deaths. 

It is difficult, says Dr. Deville, who has witnessed it, and who has kindly 
communicated to me the following description, to form an idea of this cruel, 
yet brilliant feast, which draws together devotees and the curious, from the 
most remote parts of India. After ten days' preparation, the procession, or 
rather the career of the car begins. It consists of three immense socles, 
placed one above another, and supported by axle-trees, mounted upon wheels. 
Upon the highest socle, is a canopy, beneath which is placed the niche, which 
encloses the idol. The ornaments which decorate the car, are magnificent. 
They employ for this purpose, the richest stuffs, and the most precious jewels. 
They burn the most exquisite perfumes, in vases placed around the idol, and 
troops of musicians are seated upon the steps of the car. Bayaders dance 
and sing hymns, and the brahmins, standing before the idol, fan the god with 
the punkah, (fans). They attach cords to the car, of such length, that the 
thousands of Indians who lay hold of them, may draw it. While on its course, 
which is one of about twenty miles, the devotees precipitate themselves before 
it, and are crushed (to the number of from four to five hundred), beneath the 
wheels of the car, while nothing impedes its progress. Others make inci- 
sions in their arms, upon their legs or over the whole body, and, dripping with 
blood, brave the intense heat of the sun, together with their pain, and follow 
the procession, uttering cries of joy. 

Political leaders have sometimes borrowed their supports from religious 
ideas, in order the better to cherish a contempt for death, in the hearts of 
people exposed to frequent wars, or who have become conquerors. Odin, 
being conscious that his end was approaching, transfixed himself with an ar- 
row, in presence of his friends and lieutenants, saying to them that he was 
going to Scythia, to precede them at the banquet of the gods. The Scandi- 
navians were accustomed to throw themselves from the top of a rock, in order 
to free themselves from the infirmities of old age ; persuaded that if they de- 
voted themselves to death, they should occupy a more distinguished place in 
the Valhalla. The same was true among the Abyssinians. These victims of 
ignorance and of errors, both religious and political, were not, certainly, sui- 
cides. They all yielded to the beliefs, usages, prejudices and customs of their 
respective countries, which are often more powerful than even the instinct of 
self-preservation. Christianity, by dissipating pagan errors, removed, wherever 
it penetrated, the opinion that it is lawful to take one's own life in honor of 
the divinity, and proscribed this custom ; causing, at the same time, to cease, 
the offering of human sacrifices, which defiled the worship of the gods. 



SUICIDE PROVOKED BY THE PASSIONS. 

A few words will satisfy the most incredulous, that the passions, when 
strongly excited, ever produce disturbance, either in the organism or under- 
standing of man. When the soul is strongly moved, by a violent and unexpect- 
ed affection, organic functions are perverted, the reason is disturbed, the indivi- 
dual loses his self-consciousness, is in a true delirium, and commits acts the 
most thoughtless ; those most opposed to his instinct, to his affections and in- 
terests. Thus, terror often takes away the thought of flight, and urges its vic- 
tim into perils, greater than the danger he would shun. Love deprives him 
who is powerfully impressed by it, of all those qualities proper for the ac- 
complishment of his desires ; while anger and jealousy, lead the man who is 
endowed with the mildest disposition, to imbrue his hands in the blood of his 
best friend. A sudden and unexpected trial, love betrayed, ambition disap. 



SUICIDE. 257 

pointed, honor compromised, the loss of fortune, by overthrowing the reason, 
deprive man of the power of reflection. Does the delirium of the passions 
permit man to reflect ? Do not all laws acquit him who has committed, dur- 
ing the first transports of a violent passion, an act, which would have been 
criminal had it not been for this circumstance ? The actions of a man, 
transported by a sudden passion, are regarded as performed without free 
agency ; and are judged of, as the effect of a temporary delirium. Strong 
men, of a sanguine temperament, of great susceptibility, and of an irascible 
disposition, are impelled to suicide by an impulse so much the more strong, 
as the impression has been unexpected ; and the passion a social one, sudden- 
ly called into exercise. But the acute delirium provoked by the passions, is 
temporary, and the suicide which it provokes is promptly executed. If not 
consummated, the impulse is not, ordinarily, renewed. The fruitless attempt 
seems to have been the crisis of the moral affection. The involuntary and 
acute form of suicide is very different from that which is chronic, and the 
result of premeditation. Examples of acute suicide produced by disorder of 
the passions are so frequent, that it will be sufficient for me to point out a 
small number of them. The trustee of the fortunes of his fellow-citizens, 
loses at play the money that has been committed to his care. His honor is 
lost, and he blows out his brains. 

A merchant meets with a considerable loss. Fearing that he shall not be 
able to fulfil his engagements, he goes and drowns himself A shoemaker, 
forty-five yearg of age, dwelling near the Place du Louvre, enjoying good 
health, and doing a very prosperous business, had passed the day with his 
family. Very early on the following morning, he opens his shop, and goes to 
drink, as was his custom, a glass of brandy at the store of the grocer, his 
neighbor. He returns, and about ten minutes afterwards, his workmen, on 
coming in to their labor, find this unhappy man prostrate in his back shop. 
He had laid open his abdomen with a shoe knife, and the intestines had fallen 
from this cavity. We were informed that he had lost, two or three days pre- 
viously, a considerable sum, and that he had nothing left wherevvith to fulfil 
the engagements which he had contracted for the day on which he destroyed 
himself, which was the last of the month, 1820 

Mad'e G., who had just married a young man to whom she was attached, 
has a violent altercation with her mother respecting her husband. She went 
out hastily. Not seeing her return, her sister was sent to look after her. On 
passing near the Rhone, the child saw the garments of her sister, floating on 
the surface of the river. Her mother, who had followed at no great distance, 
at this sight, escapes from those who were called together by her cries, and at 
once follows her unhappy daughter. (Vide Matthey Diseases of the Mind). 

Mad'e S., about thirty-two years of age, surprises her husband in company 
with her sister. The latter deliberately insults her. She immediately declares 
to her husband that he shall no longer have a wife, and throws herself from 
a very low window. It only caused certain slight contusions. They hasten 
to her assistance. While they are carrying her to her bed, she groans, and 
expresses much regret that she has not accomplished her designs, and repeat- 
edly assures them that the attentions they are lavishing upon her are of no 
avail. They offer her drink, but she refuses it, as well as the nourishment 
which is brought to her. She replies to no question. Her husband testifies 
the most sincere regret and affiection. Far from yielding to his solicitations, 
whenever he approaches her bed, or speaks to her, her appearance changes, 
and she becomes convulsed. She passes six days in this condition, nor does 
any thing succeed in overcoming her resolution to take no nourishment. I 
was called on the sixteenth day. The patient was very much enfeebled, her 
eyes were haggard, the pulse feeble, frequent and intermittent, and the skin 
hot. The patient complained of no pain, but sighed profoundly. She replied 

33 



258 SUICIDE. 

to my questions by nods. I induce her to swallow three spoonfuls of sugared 
water, which she does with great difficulty. After this she is unwilling to take 
any thing. The next day she expires, after a general perspiration of some 
hours. Lucretia cannot survive the outrage which Sextus has committed, and 
sheathes a poniard in her breast. The Roman generals, in their civil wars, 
were accustomed to take their own lives after the loss of a battle ; ashamed 
of their defeat, and unwilling to submit to the authority of the victor. 

But the most violent passions do not always impel the passionate man sud- 
denly to the commission of acts of fury. When the passion is primitive, or 
the moral impression has been foreseen, its action is less rapid, especially 
when it operates upon enfeebled subjects, or those of a lymphatic tempera- 
ment. The secret prey of hatred and jealousy, and of miscalculations with 
respect to schemes of ambition and fortune, man arrives slowly, and by suc- 
cessive paroxysms, to the most fatal resolutions. Although acting slowly, the 
passions do not less enfeeble the organs, nor less disturb the reason. They 
are not less likely to destroy life, and when time is still afforded to relieve 
these wretched beings from their peculiar fury, they present all the features 
of despair, as well as the characteristics of lypemania. Many have made at- 
tempts upon their lives, without knowing what they were doing ; and many 
have assured me, that they recollected nothing that they had done. Many 
also, had singular hallucinations. This, though voluntary suicide, is chronic. 
It is to this variety, that we are to refer that form of suicide which is resolved 
upon through hatred or weariness of life ; which last, appears to me to offer 
important considerations. Chronic suicide has, more particularly, given rise 
to discussions respecting the criminality of self-murder, because it presents 
the characteristics of a premeditated act. It is not, perhaps, so much with 
respect to the act, in itself considered, that this dissidence exists ; for it is 
certain, that up to the moment of its execution, he who attempts his own life, 
almost always resembles a man in a state of despair, connected with delirium. 
Physical suffering, which often leads to lypemania and hypochondria, also 
causes suicide. It changes the sensations, concentrates the attention, impairs 
the courage, and destroys the reason, by modifying the sensibility so as to ac- 
cord with the prevailing passions. Its action however, is slower than that of 
moral suffering, and rarely provokes self-murder. The man to whom physical 
suffering leaves no moment of relief, who perceives not the limit of a long 
and cruel malady, after having at first supported his ills with resignation, at 
length becomes impatient. Overcome by sufferings which have for a long 
time enfeebled him, he takes his life, to put an end to these intolerable evils. 
He considers that the pain of dying is but temporary, and yields to premedi- 
tated despair. It is the same moral condition, that determines the suicide of 
hypochondriacs ; all of whom are persuaded that their sufferings are greater 
than one can conceive, and are never to terminate ; partly, on account of their 
extraordinary nature, and in part, in consequence of the impotence of art, or 
the ignorance of physicians. There is no condition which inspires more fear 
of death, and stronger desires to be relieved from present sufferings, than hy- 
pochondria. Hypochondriacs fear to die, from pusillanimity ; they dread to 
live, from weakness. Finally, hypochondriacs converse much respecting 
death. They often demand it, at the hands of those who are about them. 
They make attempts, but rarely do they accomplish their purposes ; the slight- 
est motives, the least pretext, causing them to delay, or abandon their pur- 
poses. They resemble poltroons who talk loudly, in order that they may be 
regarded as men of courage. The father of Licinius Ca;cinius, of pretorian 
rank, overcome by the pain and weariness attending a long sickness, takes a 
large dose of opium. Haslam mentions the case of a man who took his own 
life, being no longer able to endure the sufferings of the gout. 

A girl, sixteen years of age, when on the point of being violated by her 



SUICIDE. 259 

own father, experienced such a degree of horror at the thought, that she had 
violent convulsions. The next day but one, she took at once, an opiate po- 
tion, prepared for several days. The symptoms that supervened were very 
serious, and she remained subject to nervous attacks, very frequent and vio- 
lent in their character. Two years afterwards, tired of this condition, she 
swallowed fifteen grains of tartar emetic. She vomited much, and the con- 
vulsions were auo-mented. She was sent to Paris when nineteen years of ao-e. 
She was tall, of a pretty full habit, and of a rosy complexion. However, she 
experienced almost constant sufferings, and convulsions the most varied and 
peculiar. She was successively blind, deaf or dumb, and incapable of walking 
or swallowing. This state persisted, sometimes for some hours, at others, for a 
day, and even two days in succession. Sometimes her tongue projected two 
inches from her mouth, and was tumefied. At other times, the patient could not 
swallow, whatever efforts she might make. In one instance, she passed seven 
days without being able to take any thing. I have seen her fall at full length 
upon the floor ; now upon her back, and now her face. I have seen her turn 
round and round for an hour, without its being possible for four persons to 
prevent it. I had applied a blister to the left leg, and when she became blind, 
deaf, mute, or incapable of motion, the application of a single drop of vinegar 
upon the blistered surface, suddenly restored her sight, hearing, speech and 
power of motion. After fifteen days, this measure ceased to be of use. All 
concluded that this patient was hysterical. So often was she told of the bene- 
fits that matrimony would produce, that at length she permitted herself to 
be drawn into it, solely for the sake of being cured thereby. After seven or 
eight months, seeing no chancre in her condition, she swallowed twelve grains 
of tartar emetic. She made the most violent vomitive efforts, and rai.sed a 
little blood. However, she recovered from the consecutive symptoms, but not 
from her nervous troubles. In a state of despair, she disappeared. Her rela- 
tives and friends believed that she had drowned herself Four months after- 
wards, while passing near St. Martin's gate, I felt myself seized by the collar 
of my coat, and made a strong effort to disengage myself: " You shall not 
escape me," said a voice which I recognized ; I turn, and exclaim ; " what 
are you doing. Mademoiselle? "I am cured. Have I not done every thing for 
my restoration to health ; and endeavored in vain to terminate my deplorable 
existence ? Has not every one frequently afiirmed, yourself among others, 
that marriage would cure me, whoever might be willing to form that connec- 
tion with me ? Well, if the horrible remedy which I am now employing does 
not cure me, I will throw myself into the river." This wretched being was 
clad in the tattered garments of the most abject prostitution, was reduced to 
the greatest misery, and often without the means of satisfying the most press- 
ing wants of nature. Six months afterwards, she had an abortion, and her 
nervous difficulties, the convulsions and phenomena described above, were, 
after this event, less intense and frequent. A year subsequently, that is to 
say, twenty-two months after she began the life of a prostitute, she was con- 
fined. From that period, almost all the symptoms disappeared. She retired 
to the house of a female domestic who had served her, and on her arrival at 
Paris, was perfectly restored. She begged permission to return to her family, 
was sometime afterwards married, and became the mother of four children. 

When maniacs commit self-murder, they do it without reflection. They 
usually throw themselves from a height ; a circumstance which proves that 
they obey a blind impulse, by the employment of a means the most easy and 
accessible. Maniacs are affected by illusions; perceive imperfectly the rela- 
tions of things, and are often pursued by panic terrors. They are the sport 
of their sensations, or of the hallucinations which constantly deceive them. 
One, wishing to descend the stairs, and believing that he is opening the door 
of his apartment, opens the window, and precipitates himself to the ground. 



260 SUICIDE. 

Another, estimating distances imperfectly, and believing that he is on the 
ground floor, throws himself out of the window. This latter person, wishes 
to do violence to a woman who waits upon him, and throws himself from the 
stair-way of the third story, hoping to arrive at the bottom before she escapes 
his pursuit. A maniac, impelled by hunger, was accustomed to eat whatever 
came in his way. He dies suddenly, and on examining his body, they find a 
spunge that he had devoured, and which rested in the oesophagus. Some ma- 
niacs destroy themselves while endeavoring to perform feats of strength and 
address. There are maniacs who suffer from a violent cephalalgia, and who, 
by striking their heads against the walls, experience relief Others believe 
that they have some foreign body in the cranium, and hope to remove it by 
opening the head. We have seen them destroy life by smiting themselves for 
this purpose. Maniacs also destroy themselves at the commencement of the 
disease, driven to despair by the moral affection which has caused the deliri- 
um, or coincided with its explosion ; the recollection of this affection, not be- 
ing destroyed by the delirium, which has not yet invaded the entire understand- 
ing. This class of patients also take their lives, because they have a know- 
ledge of the disease which is commencing, and which plunges them into des- 
pair. There are those who destroy themselves during convalescence from 
mania, rendered desperate by the excesses they have committed, or ashamed 
of having been insane. Finally, (we must confess it), there are those who 
destroy life while making efforts to disengage themselves from means of re- 
straint, unskilfully applied, or to escape from places in which they had been 
confined. Those who are suffering from a fever, in their delirium destroy 
themselves, like maniacs. 

Every case of monomania may lead to self-murder ; whether the monoma- 
niac obey his illusions or hallucinations, or fall a victim to a delirious passion. 
A monomaniac hears an internal voice, which is constantly repeating ; slay 
thyself, slay thyself; and he takes his life, in obedience to a superior power, 
whose mandate he cannot disobey. A man, whose brain was deranged by 
some obscure and mystical notions, believed that he was in communication 
with God. He hears a celestial voice which says to him : My son, come and 
sit dmvn at my side. He springs from the window, and fractures a leg. 
Whilst they are raising him up, he expresses much astonishment at his fall, 
and particularly on finding himself wounded. A soldier hears an organized 
hurdy-gurdy. He thinks he is listening to celestial music, and at the same 
time sees a luminous chariot, which is coming to bear him away to heaven. 
He very seriously opens the window, extends a leg to enter the car, and falls 
to the ground. 

M. A., of a bilious-sanguine temperament, was addicted to onanism from 
childhood, though it did not impair the development of his physical and intel- 
lectual faculties. He was endowed with a very active imagination, followed 
Bonaparte into Egypt, and held there an important office. At about the age 
of thirty-two, some years after his return to France, he was stricken with apo- 
plexy, the effects of which were dissipated by abundant bleedings. Some 
years later, he fell from a horse, wounding his head severely. This was fol- 
lowed by a furious delirium, of six weeks' duration. From that period, he 
manifests a slight degree of aberration of mind, and becomes difficult, queru- 
lous, and subject to transports of anger. After two years, he suddenly resigns 
a very important post, on pretext of devoting himself entirely to a project 
which he had long before conceived, and which consisted in uniting all people 
under the government of the Emperor. From that period, either from regret, 
or from want of occupation, the ideas became more disturbed, and he sets 
himself to tracing upon paper, the plan of an edifice, which shall have as ma- 
ny compartments as there are different tribes of men ; with a centre, for the 
chief of all the assembled people. This plan was made and re-made, drawn 



SUICIDE. 261 

and drawn again, several times, with the addition of innumerable and very 
inexact calculations. Two years pass away, in the most persevering occupa- 
tion, in order to finish the plans, and to submit them to new calculations. He 
now experiences a keen moral affection. He is anxious to execute his pre- 
tended project, and begins, by causing his chateau to be pulled down, and mak- 
ing a smooth place, in order to construct the foundations of the new edifice. 
Every representation which is made with respect to his project, excites his 
anger. After several acts of violence, always provoked by the obstacles which 
he experiences in the execution of his design, he is brought back to Paris, 
half pleased and half sad, at the idea of entirely abandoning his preparations 
He then persuades himself that he ought to perform some brilliant act. In 
order to prove that he has received a special mission, and to control public 
opinion, he assembles together the poor, seats them at table, and serves them 
as a domestic. He throws himself into the Seine from the Pont Neuf, and 
regains the shore without accident. This first proof confirms him in his 
opinion. The next day he goes into the streets, throwing himself beneath 
the wheels of the heaviest carriages, assuring all that he cannot be wounded. 
The day following, they prevent him, when about to jump from the window of 
his chamber. Whilst they bear him to his bed, he bitterly deplores the ill 
success of his efforts, and complains that they do not understand him, and of 
the obstacles which they oppose to his designs. He is placed in a house devot- 
ed to the insane. He several times endeavored to perform extraordinary feats, 
which would compromise his life, and always, to prove his mission. At length 
he was convinced that they would permit him to make no further attempts. 
Well, said he one day, since they prevent me, I will do nu more. He engages 
in writing out upon the walls, and on paper, his project for the reunion of all 
people. By degrees, his sentences, even upon this subject, indicate less con- 
nection and coherence of thought. Five years after his first attempts at sui- 
cide, he writes words, whose letters, instead of being placed horizontally, are 
written one above the other ; or else he makes figures without order, to which 
he gives strange appellations. He is however rational, when he speaks of 
things foreign to his delirium. He is so entirely occupied in writing his let- 
ters, words, lines and figures, which he calls his work, that he rises at earliest 
dawn, and sometimes refuses to eat; pretends to be more entirely engrossed 
than any other man, retires reluctantly, and speaks of his labor as a man de- 
voted to study, or to a most important undertaking, would do. During the 
heats of summer, he suffers from nervous agitation, when he cries both night 
and day ; speaks of his undertaking, and complains of not being able to exe- 
cute it. He has not again made the slightest attempt to establish his mission. 
Dr. Marc has made us acquainted with the following case,* published by Dr. 
Ruggieri, an apothecary at Venice. It indicates the influence of lypemania, 
over the determination to self-murder, and the obstinacy of those patients who 
are subjected to it. Matthew Lovat, a shoemaker of Venice, who was con- 
trolled by certain mystical notions, castrated himself, and threw the genitals 
out of the window. He had prepared himself beforehand, with every thing 
necessary to dress the wound, and experienced no serious consequences from 
it. Some time afterwards, he persuaded himself that God had commanded 
him to suffer death upon the cross. He reflected two years upon the mode of 
executing his project, and occupied himself in preparing instruments lor his 
sacrifice. At length, the day arrives. Lovat crowns himself with thorns, 
three or four of which penetrate the skin of his brow. A white handkerchief, 
tied tightly around the flanks and thighs, conceals the mutilated parts. The 
rest of the body is naked. He takes his seat upon the middle of the cross, 
which he has made, and adjusts his feet upon a bracket, which was attached 

* Medical Library, Sept., 1811. 



262 SUICIDE. 

to the inferior branch of it. The right foot reposes upon the left, and he 
transfixes them both, with a nail five inches in length, which he drives, with a 
hammer, to a considerable depth into the wood. He then transfixes succes- 
sively, both his hands, with long and very sharp nails, by striking the heads of 
them against the side of his chamber. He then raises his hands thus pierced, 
and brings them in contact with those which he had previously placed at the 
extremity of the two arms of the cross, in order to cause the nails, there 
placed, to penetrate his hands. Before nailing the right hand, he avails him- 
self of it, to make, with a sharp shoemaker's knife, a large wound in the left 
side of his chest. This done, with the assistance of cords previously prepar- 
ed, and slight movements of the body, he causes the cross to slip, which falls 
outside of the window, and Lovat remained suspended in front of the house. 
On the follov/ing day, he was still there. The rigrht hand, alone, was detached 
from the cross, and hung by his side. They removed the wretched man from 
this terrible situation, and brought him immediately to the Imperial clinical 
college. M. Ruggieri perceived that no wound was mortal. Lovat recovered 
from his wounds, but not from his delirium. It was observed that durino- the 
exasperation of the delirium, he did not complain, whilst he suffered dread- 
fully, during his lucid intervals. He was transferred to the hospital for imbe- 
ciles, where he exhausted himself by voluntary fasts, and died phthisical, April 
8th, 1806. 

Nostalgia leads to suicide The ranz des vaches, and the notes of the bag- 
pipe, through the influence which actual sensations have over the ideas and 
recollections, produce regret at being no longer in the country of their birth ; 
and grief, at being removed from the objects of their earliest attachments. 
Hence, springs up a violent desire to revisit the places where they were born. 
The emotions thus awakened, together with their despair at being separated 
from those objects which call them into exercise, rise superior to all other feelings, 
and both Swiss and Scotch soldiers destroy themselves, if they cannot desert. 
How many lypemaniacs, who believe themselves pursued by robbers, or agents 
of government, destroy themselves, in order to avoid falling into their hands ! 
Some make no estimate of the danger they run, in order to effect their es- 
cape ; while others prefer certain death, to the torture and disgrace which are 
preparing for them. How many, who believe that they are betrayed by for- 
tune and their friends, destroy themselves, after a strugwle of longer or shorter 
duration ! They take their lives as do men, whom a passion urges slowly, to 
the commission of self-murder. 

M. B., about forty-three years of age, after having become exhausted in the 
discharge of public duties, which are committed to him, falls a victim to an 
act of injustice, and soon becomes insane. They conduct him, contrary to 
his wishes, to an estate. He then persuades himself that his wife has de- 
nounced him, and that he is ruined by the government. On the following 
day he shuts himself up in his study, places the barrel of a fowling-piece in 
his mouth, and with a horseman's pistol springs the trigger. Fortunately the 
direction of the gun is changed, and the charge passes through the cheek, 
throwing him down. His relatives hasten to him, but he refuses all assist- 
ance. However, they bleed him, and bind up his wounds; and although he 
submits reluctantly to the attentions that they bestow upon him, the wound 
is disposed to heal. The patient testifies the most violent hatred towards his 
wife ; a circumstance which, joined to his delirium and threats to take his own 
life, determines his family to send him to Paris. At his arrival, the wound is 
not cicatrized, and the patient is sad and thoughtful. He converses little, 
walks about like a man absorbed in thouoht, and often raises his hands to his 
head. His face is sometimes flushed, his complexion sallow, constipation is 
obstinate, and there is insomnia. However, he assures us that he is not un- 
well, rejects every remedy, and receives the physicians with reluctance. He 



SUICIDE. 263 

is apparently very composed, reasons with remarkable correctness, but threat- 
ens, from time to time, to throw himself from the window, especially when 
spoken to respecting his health. At the expiration of fifteen days, notwith- 
standing the most careful attention, he escapes from his hotel, and they find 
him hastening towards the quays remote from the centre of the city, in order 
to throw himself into the Seine. He is then committed to my care. After 
five months' retirement, and apparent composure, he experiences pains in his 
bowels, and cephalalgia, which are exasperated on alternate days. He 
refuses every remedy, never leaves his apartment; takes no part in ordinary 
affairs, and diverts his mind neither by reading, nor any manual occupation. 
Notwithstanding, he receives me kindly enough, and converses willingly on 
every variety of subject, excepting his own disorder, his wife, and a cousin 
who had prevented him from throwing himself into the river. No sooner 
do I touch upon either of these three topics, than his eyes kindle, his face 
flushes, he quits his arm-chair, and walks about at a rapid pace, irritated, 
and ready to give way to his anger. During the course of the fifth month of 
his retirement, and the sixth of his disease, he appeared to me more accessible 
to means employed for his diversion. He had consented to play a game at 
draughts in his apartment, and to take a laxative drink. I invited his wife to 
pay him a visit with his children ; informing her distinctly at the same time, 
that his prejudices against her had not ceased, and that his reception of her 
would be perhaps, exceedingly painful ; but that a moral commotion would be 
very serviceable to him. On the day appointed, Mad'e B. and her children, 
without being announced, present themselves to the patient. The latter im- 
mediately exclaims, with a threatening gesture; "Retire, Madam, retire." 
The courage of this lady, so devoted to her husband, does not sustain her. 
She finds herself feeling unwell, and it is necessary to assist her to withdraw 
from the apartment. Her husband retains part of the children, speaks to 
them in harsh terms of their mother, and shortly after sends them from his 
apartment. I remain alone with the patient, who walks at a rapid rate, like a 
furious man who has not a word to utter. After some minutes, he approach- 
es me, who had remained motionless, seized me by the collar, and says several 
times : " What are you doing there like a post, do you feel nothing ? How 
can I fail to be moved by this circumstance, of which I have just been a 
witness?" 

His hasty walk begins again ; and after the lapse of half an hour, he lies 
down upon his bed, and I leave him alone. An hour afterwards, he is sitting 
up when I come in : " Well said I, approaching him, you are more composed, 
will you listen to the truth ? Is it possible that you could thus treat the wife who 
adores you ? She is in an alarming condition ; and is this the price of the 
consolation that she has been accustomed to offer you ? How poignant should 
be your regrets !" The patient preserves a sullen silence, but is profoundly 
moved. In the evening, I inform him that I have conducted his wife to her 
residence, and left her in an exceedingly trying condition. Same silence. 
Two days after this, he sees his children, and speaks to them unkindly re- 
specting their mother. On the same day, I inform him that his wife is very 
ill and that her condition is the result of the reception that he had given her. 
On the fifth day he sees his children, but says nothing respecting their mother. 
During the day, he asks permission to go and see his wife. " You shall not 
see her, sir, said I. Would you still aggravate the frighttul condition which 
you have caused 1" These words are uttered in a decided tone. On the sixth 
day, he receives a visit from his children, and is more affected. He enquires 
also, after his wife. In the evening, I inform him that the health of his wife 
has improved. 

On the seventh day, he manifests some regret at what has transpired, and 
we converse in a tone of confidence. He asks permission to visit his wife, 



264 SUICIDE. 

which I grant. At the hour for dinner, he says that he will dine at hoine, 
and sends me a note of invitation. During the hours preceding and following 
dinner, he conversed with his wife and children, on general subjects and mat- 
ters of no special interest. From time to time, however, he addressed his 
wife in terms of reproach, and with insolence ; but in a voice so low, and with 
such precautions that his children did not hear his remarks. At ten o'clock, 
I go to his residence. He appears gay, receives me with an appearance of 
satisfaction, and we retire together. Two days after this, he returns to his 
family, where, for some days, he is very irascible, unkind to his wife, but very 
affectionate towards his children, relatives and friends, who visit him. A few 
months later, he was called upon to perform certain very important duties. 
He supports the disquietudes, fatigues and menaces, to which certain public 
functionaries were exposed, during the earliest period of the invasion of 1814. 
However excellent might be his health, and however important the duties 
which he had to fulfil, he could hear no one speak of the estate where he 
first attempted suicide. He would not permit his wife or children to go thi- 
ther ; and it was a year after his cure was regarded as complete, that having 
sent his wife and children before him, he returned to his province. 

An ecclesiastic thoughtlessly swallows the seal of a letter that he has just 
received. One of his friends smilingly said, you have sealed up your boioels. 
This idea takes possession of the mind of the ecclesiastic, and after two days, 
he refuses all nourishment, convinced that it cannot pass. They administered 
to the patient, says Darwin, purgatives which acted powerfully, without effect- 
ing a cure. They succeed at length, with difficulty, in causing him to drink 
a little broth. He soon refuses to swallow, and shortly dies. Was this an 
error of volition, as Darwin pretends 1 Would not Barclay have said, that 
there was a vicious association of ideas, which led to a fatal determination 1 
Weariness of life, has not been sufficiently distinguished from hatred of it, 
when writers have enquired into the determining motives to self-murder. Not- 
withstanding, these two conditions of the mind are very different. Hatred of 
life is an active state, and supposes a sort of irritation and exaltation of the 
sensibility. Weariness of life is a passive state, the effect of atony of the 
sensibility. Hatred of life is frequent, because a thousand circumstances 
provoke it. It spares no class of society, and most frequently attacks men 
abounding in wealth and dignity, because they possess more passions, which 
are called into active exercise. A prey to vexations, either real or imaginary, 
or to a chronic passion, man, at first disgusted with life, ends by hating it, 
and destroying himself I ought finally to state, that words here but imper- 
fectly express the ideas which they are designed to convey, and that from 
this circumstance, discussions have sprung up respecting hatred of life and 
desire of death. In fact, they have no aversion to life, but hate the sufferings 
which traverse it, and have a horror of their uneasiness. They do not desire 
death ; but wish to be delivered from pains, oppositions and vexations, and 
have recourse to death as the most certain means. Suicide, determined by 
hatred of life, forms one of the distinctions which we have already establish- 
ed. It appertains to lypemaniacal suicide, or to suicide produced by a chro- 
nic passion ; according as the causes which occasion hatred of life, are real . 
or imaginary. 

Weariness of life, the tfcdium vita;, leads to self-murder. Although weari- 
ness may be a passive condition, it is, in some instances, not the less a motive 
of action. Such has been the opinion of many philosophers, and I have ob- 
served, that weariness determined certain monomaniacs to do what had ap- 
peared most repugnant to them, and that they were cured by efforts made 
upon themselves, from excessive ennui. Ennui, at the epoch of puberty, ori- 
ginates in a vague desire, the object of which is unknown to him who ex- 
periences it ; and this want gives rise to an inquietude, which occasions sad- 



SUICIDE. 265 

ness, terminating in weariness. The most common effects of this tediousness 
are, decay, feebleness, and vsometimes suicide : a phenomenon noticed by Hip- 
pocrates among young girls, who either have not, or but imperfectly, menstru- 
ated. Ennui recognizes moreover as a cause, the cessation of engrossing oc- 
cupations ; the transition from a very active life to one of repose and idle- 
ness, when no occupation for the mind or affections of the heart have been 
previously formed. Weariness is also the effect of the abandonment, either 
forced or voluntary, of the fashionable world, and frivolous pleasures ; when 
the individual remains isolated, and without any interest whatever. It is .so 
much the more fatal, when, having no aptitude for the arts and sciences, one 
is deprived of the resource of pleasures, in consequence of having abused 
them. 

Man must have desires, or he falls into a state of painful weariness. But 
if he has exhausted his sensibility by the excessive exercise of the emotions 
and the abuse of pleasures ; if, having exhausted all the sources of happiness, 
there is nothing more that can cause him to feel that he still lives, and all 
external objects are indifferent to him ; if, the more means of self-satisfaction 
he has enjoyed, the less numerous are the new objects which he meets with 
that are calculated to awaken his interest ; man then occupies a frightful void. 
He sinks into a state of satiety ; a terrible weariness, which conducts to sui- 
cide. To quit life, is to him an act as indifferent as that of leaving a splen- 
didly furnished table, when he no longer desires food, or to abandon a woman 
whom he formerly adored, but whom he no longer loves. That form of sui- 
cide which is called splenic, is chronic. It is executed with coolness and 
composure. Nothing announces either violence or effort, like other forms of 
suicide. Finally, those who suffer from the spleen, present all the characte- 
ristics of melancholy. The mo.st frequent causes of spleen are debilitating, 
and act upon the nervous system. Such are the abuse of pleasures, onanism, 
and the immoderate use of alcoholic drinks. There is the same change of 
disposition and habits ; the same indifference towards the dearest objects ; the 
same physical symptoms ; loss of appetite, insomnia, constipation, emaciation 
or oedema ; the same concentration of the attention upon a single idea ; the 
same integrity of the understanding upon every other subject ; the same per- 
verseness ; and the same dissimulation in the execution of the determinations 
in the former as in the latter. 

I have strong reasons for believing that the spleen is a very rare disease, 
even in England. We too often attribute the suicides of the English to weari- 
ness of life, because England is the country in which most frequently the peo- 
ple have recourse to it. The English without doubt, suffer most from this 
distressing weariness ; still many other motives than this give rise to suicide 
among them. I have had charge, as well in establishments for the insane as 
in my private practice, of a great many individuals, who have either attempt- 
ed, or taken their lives. I have seen no one who was driven to suicide in 
consequence merely of weariness of life. All had determinate motives, real 
or imaginary vexations, which led them to loathe existence. I have even been 
deceived sometimes in this respect. A man in the enjoyment of a splendid 
fortune, had given himself up to the practice of masturbation. Nevertheless 
he was strong and in good health, and with no other cause of grief than the 
recollection of the horrors of the revolution, whose principles, besides, he ap- 
proved. He made several attempts to commit suicide, and often called for 
pistols, wishing to die by means of them. During the two years that I had 
charge of him, he was not for a moment irrational. He was gay, agreeable and 
very well informed, saying to me sometimes ; give me apisfoL Why do you 
wish to destroy yourself? I am weary of life. It was only after the lapse of 
two years, that he acknowledged to me that he had hallucinations of hearing 
and sight. He believed that he was pursued by agents of the police. He 

34 



266 SUICIDE. 

both heard and saw them through the walls of his apartment, which, he add- 
ed, are lined with planks having slides, in order that they might both hear and 
see, what he said and did. 

I have often met with a variety of suicide, of which authors have not spo- 
ken ; and which is in many respects analogous to the spleen. There are per- 
sons who, in consequence of physical causes, or variable morals, fall into a 
state of physical prostration and moral discouragement. They have little 
appetite, a dull and deep-seated pain in the head, heat in the bowels, bor- 
borygmi and constipation. Nevertheless, their external appearance indicates 
no grave disorder of the health. Among women, the menses are sometimes 
suppressed. At a later period, the features of the countenance with this 
class of patients are shrunken, the look fixed and uneasy, and the complexion 
pale and sallow. They complain of a racking pain at the epigastrium; of a 
heaviness of the head, which prevents thought, and of a torpor and general 
lassitude, which render effort impossible. They move not, but prefer remain- 
ing in bed, or sitting quietly, and are impatient when we desire them to take 
exercise. They abandon their ordinary occupations, neglect their domestic 
duties, and are indifferent to the objects of their former affections. They no 
longer engage in business, and are unwilling either to converse, study, read 
or write. They dread society, and especially the importunities to which this 
malady exposes them. Weighed down by a sense of their condition, they 
entertain gloomy meditations ; and at length, in despair on account of their 
real or pretended worthlessness, which they believe can never be surmounted, 
they desire death, call for it, and sometimes devote themselves to it ; wishing 
to die, since they believe that they can no more fulfil their duties towards their 
families or society. These patients do not reason irrationally. Their impulse 
to suicide is stronger in proportion as their occupations have been more steady, 
and their duties numerous. I have seen this malady continue for a few months, 
and also to persist for two years. I have seen it alternate with mania, and 
with perfect health. Some patients were for six months either maniacs or in 
the enjoyment of good health ; and for an equal period, overcome by a sense 
of their physical as well as intellectual and moral weakness, which caused 
them to desire death. 

M., thirty-two years of age, tall, and of a strong constitution, having never 
been sick ; the descendant of a father who, after having acquired a large for- 
tune, died in possession of little property, had received a thorough education 
with a view to carry on to its greatest extent, the trade of a locksmith. He 
is married at the age of twenty-seven years, to a woman whom he adores. 
He has engaged in several undertakings, which have not succeeded ; a circum- 
stance which has too severely afflicted him ; discouraging and rendering him 
slothful, without however impairing his health. Although depressed in mind, 
he engaged in enterprises which promised great and favorable results. He 
begins his labors with zeal ; but at the expiration of a month, on meeting with 
slight difficulties, he is unduly affected by them. He is discouraged ; believes 
he is ruined ; incapable of accomplishing any thing ; and is unwilling to leave 
his bed to oversee his workmen, or to direct their labors ; thinking that he is 
destitute of those qualities and the vigor necessary to bring his enterprises 
to a favorable issue. He suffered at times from vertigo, from heat in the 
bowels, and constipation. His affection for his wife and children, together 
with the care of his interests, were of no avail in relieving his depression of 
mind. He was impatient even, when his wife repeated her advice. He took 
a very correct view of his situation, but made no effort for his relief Eight 
days passed thus. Suddenly he was well ; manifested all his activity in his 
business, and all his aftection for his family. Relapses occurred ten or twelve 
times at irregular intervals, and were provoked ordinarily by some slight oppo- 
sition, or by difficulties which would not have occasioned them in any other 



SUICIDE. 267 

state of health. Whilst these paroxysms lasted, the patient felt dull, and his 
mind was embarrassed. He suffered from epigastric pains ; remained in bed, 
ate little, and wished to see no one. Despair, in consequence of his inapti- 
tude, of being a burthen to his family and of not being cured, often urged 
him to suicide. 

L., thirty-four years of age, was admitted into the Salpetriere Sept. 23d, 
1819. She was the offspring of healthy parents, and had the small pox when 
eight years old. She menstruated at the age of fifteen, married at twenty, 
and had a child when twenty-one. After her confinement, she had an ulcer 
on the foot, which was cured at the expiration of about six months. From 
that period she suffered from cardialgia ; at first, fugacious and slight, then 
constant and very intense ; attended with vomiting of food. After her second 
pregnancy, which occurred at the age of twenty-seven, the symptoms became 
more grave. She believed that she had a cancer of the stomach, and worried 
much on account of it. When about thirty-three years of age, she becomes 
undecided in her ideas and actions ; no longer wishing what she formerly 
ardently desired. Her thoughts were at times incoherent, though her husband 
did not notice it. Nevertheless the menstrual flow was natural. After six 
months there was insomnia, and a painful sense of constriction at the root of 
the nose, paleness of the face, and a change in its features. Her look is fixed 
and sometimes haggard. She suffers from pain at the stomach, and a sense 
of constraint and obstruction at the epigastrium, which prevents motion. She 
abandons her ordinary occupations and the cares of her household. There is 
sadness, tears, voracity or want of appetite, a desire and temptation to sui- 
cide, produced by the regret of being no longer of any service in society, and 
of feeling no longer any affection for her famdy. Such was the condition of 
the patient at the time of her admission into the hospital. She was put upon 
the use of acidulated diluent drinks and tepid baths. Three months after 
this her mind was more composed, and the patient called for occupation. She 
gives a more favorable account of her situation, but always complains of a 
fullness and racking pain in her abdomen, of menstrual suppression, and ob- 
stinate insomnia. I prescribed the whey of Weiss, and a blister to the neck. 
The irritation produced by the latter, obliged us to place it upon the left arm. 
The dejections, at first consistent, became abundant ; sleep improved ; and 
hope again revived in the breast of the patient, who labored with satisfaction. 
In February, 1820, her complexion had become clear, her physiognomy com- 
posed, and her ideas more distinct and ready. On the twenty-third of March, 
she was restored to her family, although the menses had not reappeared, but 
fully resolved to renew her usual occupations. She kept her word. The 
menses were established during the month of April. From the time of their 
appearance, she was a little more active than natural ; was more loquacious, 
and moved about more freely ; sought again the toilet, and was less sedentary. 
In the month of Sept. 1820, she became fearful of a relapse, and experienced 
a feeling as if a bar extended across the epigastrium, from one hypochondrium 
to the other. The features of the countenance change, and there is insomnia. 
These premonitory symptoms of a relapse persist for two months, in spite of 
all the efforts made by the patient in her own behalf, and the medicines that 
I advised. In the month of December, the same apathy that formerly existed, 
the same despair of ever being able to accomplish any thing, and of being 
past cure, lead to gloomy thoughts, and awaken a desire to terminate a life, 
whose duties she can never fulfil. 

There are persons who, amidst fortune, grandeur and pleasures, and enjoy- 
ing the perfect use of their reason ; after having embraced their relations and 
friends, set their affairs in order, and written excellent letters, clip the thread 
of life. Do they yield to a delirious resolution? Yes, unquestionably. Is it 
not true that monomaniacs appear rational, until an external or internal im- 



268 SUICIDE. 

pression comes in suddenly to awaken their delirium? Do they not know 
how to repress the expression of their delirium, and to dissemble the disorder 
of their understanding, so as to deceive the most skilful, as well as persons 
who live with them on terms of intimacy ? The same is true of some indi- 
viduals, over whom the purpose to commit suicide holds complete sway. A 
physical pain, an unexpected impression, a moral affection, a recollection, an 
indiscreet proposal, the perusal of a book, kindle up anew the dominant 
thought, and instantaneously provoke determinations the most fatal, in the 
breast of an unfortunate being who, an instant previous, was perfectly com- 
posed. That then happens, which took place in the case of the maniac de- 
tained at the Bicetre, of whom Pinel says, that the revolutionists set him at 
liberty, because he appeared to them perfectly sane. They led him forth in 
triumph, as a victim of tyranny, when being excited by the vociferations and 
the sight of the arms of his liberators, he suddenly fell upon them, sabre in 
hand. 

Does not the fury of the homicidal monomaniac burst forth instantaneously, 
so that no antecedent circumstance may have forewarned the victim ? We 
cannot deny that there are individuals M'hom a fatal inclination leads to sui- 
cide, by a sort of resistless charm. I have never seen such persons ; and I 
dare say that if those cases had been more carefully studied, in which they 
pretend that the patients obeyed an insurmountable impulse, it would have 
unfolded the motives which led to their determination. There are suicides 
as well as other insane persons, of whom we s-peak, as of unfortunate beings, 
who are obeying a blind destiny. I believe that many persons have learned 
to read the thoughts of these patients, and proved that their determinations 
are, almost always, the result of motives and the logical consequence of a 
principle, though it may be, in truth, a false one. There are persons, how- 
ever, who, in the midst of good fortune, destroy themselves. Voltaire, sustain- 
ed by certain striking examples, pretends that it is those who are distinguish- 
ed for their good fortune who voluntarily terminate their existence, and not the 
man who is the victim of want, and compelled to labor for his subsistence. 
This proposition is false. Misery leads to suicide, and self-murder is most 
frequent during years signalized by calamities. Amidst ruin and fiimine, sui- 
cides are frequent. During the horrors of a siege, the besieged destroy them- 
selves. Amidst defeats, soldiers take their own lives. Self-murder takes 
place during great political convulsions. The fortunate of the age destroy 
themselves; but good fortune, says Jean Jacques, has no external sign. 
To judge of it, we must read the heart of the man who appears to be happy. 

W., thirty years of age, and enjoying excellent health, solicits the hand of 
a young lady who is to secure his happiness. A few days after marriage, he 
destroys himself It was neither errors of regimen, nor good fortune which 
led him to commit this act, but the disappointment of not having found his 
wife such as he had flattered himself she was. 

A man twenty-seven years of age, like the former, married to a charming 
girl, at the expiration of six months after marriage, makes a thousand at- 
tempts upon his life. Because his wife is of a sedate and quiet disposition, 
this unfortunate man persuades himself that she is unhappy, that he is the 
cause of her unhappiness, and that she can never enjoy herself with him. 
He was wealthy, and a man who was held in the highest estimation ; had a 
charming wife, and all in the province regarded him as at the summit of hap- 
piness. Thus the individual whom we believe happy, is racked with inward 
griefs, and tortured by some passion. The splendor by which he is surround- 
ed, does not permit us to see the anguish of his soul. A man who should 
destroy himself, and who should be at the same time truly happy, would be a 
phenomenon of which human reason cannot conceive. When it is said that 
men most eminent by their rank, fortune, and the consideration which they 



SUICIDE. 269 

enjoy ; in fine, that men in appearance the most happy, destroy themselves, it 
is true; because they, more than others, are influenced by a great variety of 
causes which impel them to this fatal decision. 



SUICIDE PRECEDED BY HOMICIDE. 

Who will ever reveal that disorder of the organism, which urges on the 
madman who desires his own destruction, to acts the most atrocious, before 
executing his deplorable resolve ? I will not attempt a task so difficult. The 
facts which acquaint us with the motives which determine the greater part of 
these wretched beings, arc not few. It is remarkable, that all the cases of sui- 
cidal monomania which have been published previous to this period, present 
striking analogies one with another ; and that they offer indications of mental 
alienation, particularly of lypemania. Almost all homicidal suicides are lype- 
maniacs, controlled by a passion carried even to delirium ; but aside from this, 
enjoying the use of their reason. Certain motives, more or less plausible to 
their minds, determine them, and they select for their victims the objects of 
their strongest attachment. They commit the homicide with composure, at 
least in appearance. After having consummated their purpose, they are not 
disturbed, nor uneasy. They are more composed after having committed it 
than before, and sometimes appear content. Some make a declaration of 
their crime to the police and tribunals, or speak of it to those they meet. Far 
from concealing themselves, they await the period of arrest, and demand that 
they may suffer capital punishment. The form of suicide which succeeds an 
act of homicide is usually acute ; sometimes however, it is chronic, and offers 
all the characteristics of a reflected and voluntary act. I have seen monoma- 
niacs take their own, after having taken or attempted to take, the life of an- 
other. 

M. H., twenty-seven years of age, is for several days in a state of acute 
mania. He falls to beating with a chair, a woman whom they place near him, 
and whom he thinks they desire to make a substitute for his mistress. He 
wounds her, and is so excessively frightened at the sight of blood, that he pre- 
cipitates himself from the window of the fourth story. 

A lady, during an attack of lypemania, which caused her to fear being ar- 
rested, condemned, and conducted to the scaftbld ; rendered desperate by the 
o-rief which she thinks she shall cause her husband, endeavors to take his life, 
by beating him on the head with a stone, before destroying her own. 

The Journals reported the case of a Belgian lady in 1815, who, after hav- 
ing thrown four of her children into a well, precipitated herself into it after 
them. She would have subjected a fifth to the same fate, had he not escaped 
her. She had also sent a poisoned cake to a sixth, who was abroad at school. 

Mad'e R., thirty-two years of age, the offspring of a melancholic father, of 
a bilious-sanguine temperament, at the age of eight years meets with a fall 
upon her head, from which she suffered for a long time. Her mother feeling 
for her little attachment, she was boarded away from home until near the time 
of her marriage. Having menstruated at the age of fifteen, she married at 
sixteen. At nineteen, a second pregnancy was succeeded by melancholy, with 
some thoughts of suicide. This condition was dissipated by a third pregnan- 
cy. When thirty -one years of age, during a fourth pregnancy, she preserved 
her gayety, and enjoyed very good health. Her confinement was a happy one, 
and she nursed her infant. She exhausts herself however, and becomes ema- 
ciated. At the eighth month of lactation, she becomes sad, impatient and 
irritable towards her husband. She was heard to complain that she had chil- 
dren. She is impetuous in her treatment of her nursing child. Several times, 
she was observed to press it, as if with a view to stifle it. In one instance, 



270 SUICIDE. 

during the absence of her husband, she threw it out of the window. From 
that time, they permitted her to have charge of her child only while nursing. 
Some days subsequently, there was sadness, insomnia and inappetence. She 
was apathetic, and knew not how to behave. She felt incapable of doing any 
thing, deplored her own and the misfortune of her children ; persuaded, that 
both herself and husband were ruined. She saw her children clothed in rags, 
running about the streets, holding out their hands for charity. This thought 
filled her with despair, and led her to form the resolution to destroy them, and 
afterwards herself. However, maternal tenderness maintained its sway. If 
she would caress her children, or if indeed she approached them, she shud- 
dered, and the purpose of slaying them immediately recurred to her mind. 
A moment afterwards, she deplored her situation, formed the resolution to re- 
sist these horrible designs, and responded, by promises, to the exhortations of 
her family. 

After several months, she desired to change her residence : saying, that if 
removed, she should not injure her children. She was accordingly sent into 
the country among her friends. She appeared more composed, and manifested 
a desire to return to her children. Her wish was gratified ; but, a few days 
afi;erwards, the same thoughts awoke again in her breast, and she was sent 
back into the country. I was consulted in the month of December, and advis- 
ed her husband to keep her until spring. During the three winter months, 
she went and came; had alternate seasons of composure and excitement; 
was much emaciated ; and her complexion was pale. She swallowed some of 
the oxyd of copper, that she had collected by scouring utensils of this metal, 
and made several efforts to throw herself into the water. One day, when most 
sad, her mother proposed to her to go into the country ; " Let us go immedi- 
ately," said she smiling. On the way, she was in very good spirits, hoping to 
find the rat's-bane which she knew had been sprinkled about the house ; but 
her mother, having penetrated the cause of her contentment, had sent to pre- 
vent it. On arriving at her residence in the country, she hastens all over the 
garrets, but finds only a morsel of the paste which had escaped the search of 
the domestics. This she swallows, without however suffering any inconve- 
nience. 

She is committed to my care April 10th, 1816. Her complexion is sallow, 
her cheeks flushed, her eyes haggard. There is emaciation, a burning skin, 
headache, pains at the epigastrium, obstinate constipation, and pains in the re- 
gion of the urinary organs. She remains sad and silent ; and is tranquil until 
nine o'clock at night, when she becomes agitated, swears, reproaches and abus- 
es her absent husband, and complains of having been sent to Paris. During 
this time her countenance is very much flushed, she walks about rapidly and 
with naked feet, threatens those persons who surround her, and howls. No- 
thing can, for an instant, divert her attention, nor produce composure of mind. 
At five o'clock in the morning the paroxysm ceases, and is followed by an 
abundant flow of tears. At my visit, she demands her liberty. " Can you 
have forgotten your vociferations, and the transports of the night?" No, no, 
sir, but I have to complain of the ill treatment of my relatives, and of my pre- 
sent confinement, which is unjust, since I am not insane. The paroxysms are 
renewed almost every night, and at nearly the same hour ; rarely taking place 
during the day. They are announced by redness of the face, and characte- 
rized by frightful oaths, liorrible cries, and reproaches against her family ; by 
insults and threats towards those who surround her, and by pelvic pains, which 
exasperate her. I ordered a laxative drink, and a vapor bath, daily. From 
the commencement of the month of May, I order a tepid bath on alternate 
days, a douche during the bath, and the vapor bath every evening, with cold 
water to the head. 

May 2.5th, at four o'clock in the morning, she has a paroxysm, which proves 



SUICIDE. 271 

to be the last. At half past seven, the housekeeper, to whom I had given my 
instructions, enters her apartment, and with a iirm and assured tone rebukes 
her, and assures her that she shall no longer remain in her house ; and finally, 
if she does continue, she shall spend the remainder of her life, and that, with 
the approbation of all her friends. The patient is struck dumb, on hearing 
such language from a lady who had heretofore treated her with much civility, 
and in whom she had testified great confidence during her lucid intervals. 
After some moments of thoughtful silence, she promises to make an effort to 
control herself On the same day, she asks permission to visit the housekeep- 
er, but is refused. The domestics had been ordered to observe the most per- 
fect silence. This privation was continued for three days, during which, calm 
and thoughtful, she was accustomed to walk in the garden, and was admitted 
to the table of convalescents. The trial having passed, on the 28th of May 
I permit her to see the housekeeper. On meeting, these ladies embrace, and 
Mad'e R. thanks the matron for her firmness, and weeps with her, in view of 
the dreadful nature of her disease. 

From this epoch, I observed a most favorable change. The patient can 
comprehend the language of friendship and attachment. She accepted those 
means of diversion that were proposed, and I begin to encourage her, in op- 
position to that fear which she entertained, that she should never recover. 
The Seidlitz waters not relieving the constipation, I had recourse to Ol. ri- 
cini, which provoked abundant dejections. About the middle of June, she 
became decidedly convalescent. She was more cheerful, her sleep was better, 
and the pelvic pains had ceased. She does justice to the tenderness of her 
husband, and the affection of her relatives, and desires to return to the bosom 
of her family ; yet without manifesting impatience or obstinacy. She takes a 
very correct view of her past condition, and was grieved in consequence of it, 
but did not despair. On taking leave of us, she went to reside among her 
relatives ; and the sight of her mother was most sratifyino- to her. On the 
14th of September, she was restored to her family, and passed another month 
at Paris, in diversions constantly renewed ; after which she returned to her 
husband and family, whom she regarded with the same affection as before her 
illness. One year subsequently, the husband of Mad'e R. died. Excessive 
grief, occupations foreign to her habits, affairs of interest which it was neces- 
sary to arrange, together with the diminution of the means of subsistence, 
far from impairing her health, confirmed it : for until then, she felt that some- 
thing was wanting, of the plenitude and activity of her faculties. Such is 
the confession which, ten years afterwards, this lady made to me, having had 
another attack, attended with different symptoms, and continuing longer than 
the preceding. 

A lady, thirty-six years of age, and the mother of a family, nursed her infant. 
In consequence of certain moral affections, she was seized with a desire to 
die. But said she, / have not the courage to take my own life ; and in order 
to cause the law to reqtiire it, I must take the life of some one ; and in fact she 
attempted to slay both her mother and children. When brought to our hos- 
pital she was very much emaciated, sad, spoke not, refused to eat, and wished 
to take no remedy. She presented all the characterestics of profound melan- 
choly. The threat that she should otherwise be covered with vesicatories, 
induced her to take some of the whey of Weiss, which relaxed her bowels. 
The extract of bark and musk were given for more than a month, when 
we returned to the use of purgatives. The patient was less sad, but often 
repeated; " I must slay some one, in order that I may die." She was bathed 
during the intense heats of summer, and received the douche several times 
during the month of September, and a second vesicatory is also applied. 
She appeared at this time, manifestly better, and her relatives desired to re- 
move her during the month of October. She was then emaciated, but her 



272 SUICIDE. 

complexion was clearer, and the features of her face less shrunken ; she took 
exercise more willingly, ate and slept well, and spoke no more of taking the 
life of any one. Nevertheless, the menses had not reappeared. I have un- 
derstood, that on being restored to her family, this woman had resumed her 
former habits and enjoyed very good health. 

Crichton* cites several examples of homicidal suicide, taken from German 
authors. Those unfortunate beings who constitute the subjects of his obser- 
vations, being unable to resolve to destroy themselves, have taken the lives of 
others, hoping thereby to be condemned to death. Examples of those who, 
during a paroxysm of jealousy, of anger or revenge, have slain the object of 
their passion, and then themselves, are not rare. We had at the Salpetriere, 
a woman who desired to hang herself Her brother, having become enamor- 
ed of his own sister, on learning that she was about to be married, stabbed 
her, and threw himself from the window. A shoemaker, for ten years a me- 
lancholic, imagines that the purchase of a house that he has made, has been 
the cause of his own misfortune, and that of his wife. During a fit of de- 
spair, he slays his wife, three of his children, and would have slain the fourth 
had he not escaped his rage. After this horrible sacrifice he lays open his 
own abdomen, and the stroke not being mortal, he drew again the instrument, 
and transfixed his heart. This man enjoyed a good reputation, and was of a 
mild disposition. , 

Thus, among those wretched beings who destroy others, before taking their 
own lives, some obey those vehement passions which lead them quickly to 
this double homicide. Others are aroused by passions whose effects are slow 
in manifesting themselves. There are those who are unwilling to destroy 
themselves, through fear of eternal condemnation ; knowing that suicide is a 
great crime, for which they could not obtain pardon. They are however, 
certain of being condemned to death after taking the life of a fellow-beino". 
and hope to have time, before their punishment, to reconcile themselves to 
God, and to prepare for a happy death. There are those who slay the dearest 
objects of their affection, in order to preserve them from the trials of life and 
the dangers of condemnation. Finally, we have seen those who slew the ob- 
jects of their tenderest attachment, being unwilling to be separated from 
them, and believing that they should be reunited after death. Is it possible 
to believe that such a violation of the fundamental laws of nature ; such exal- 
tation of the imagination ; such perversion of the sensibility ; can be compa- 
tible with the enjoyment of sound health and the integrity of reason ? Must 
he not, on the contrary, have reached the extreme limit of delirium, who re- 
solves to take the life of the wife whom he tenderly loves, and the children 
whom he adores 1 Does he not abandon himself at once, to acts most op- 
posed to natural laws, and the instinct of self-preservation? Notwithstanding, 
many facts prove that these unfortunate beings, aside from this act, both be- 
fore and after its accomplishment, are composed and rational. Do we not 
observe this composure and reason among those maniacs who, from the 
slightest motives, from the most trifling opposition, give themselves up to the 
commission of acts indicative of the blindest fury ? It is not the si^ns of 
delirium on the part of those who commit suicide, that are wanting ; but ob- 
servers who are at hand to see all, and to see correctly. 

Reciprocal suicide is that act by which two individuals slay, one the other. 
It is generally the delirium of some passion, and sometimes extreme wretched- 
ness, which lead those who are their victims, to devote themselves to death. 
The same passion, leading to the same determination, finds a certain charm 
in dying by the hand it adores. Examples of this form of fury are not rare, 

* An Inquiry on tlie Nature and Origin of Mental Derangement, London, 1798, 2 vol. 
in 8vo. 



SUICIDE. 273 

and we can trace them back to the remotest antiquity. The most memorable 
is that of Arria and Poetus. The latter was condemned to suffer death for 
having conspired against Claudius. Arria his wife, not wishing to survive 
her husband, plunges a poniard into her breast. She withdraws it, and pre- 
sents it to her husband, saying : take it, Pectus, it gives no pain. Their 
daughter was desirous of imitating her mother, under similar circumstances. 
She opens the veins, but her husband who was condemned to punishment, 
entreats her, and obtains her consent to survive him for the sake of their 
children. 

Richard Smith, in 1726, presented a strange spectacle to the world. He 
had been rich, but was now poor and infirm. He had a wife and an infant 
child, with whom he could share nothing but misery. Richard Smith and 
Bridget Smith, by common consent, after having tenderly embraced and given 
a last kiss to their child, and slain it, hung themselves from the posts of their 
bed. A letter was found written by their own hand : " Tf e believe that God 
will pardon us. We have resigned our life because we icere miserable, and with- 
out resources. We have also rendered to our only son the service of slaying 
him, for fear that he might become as lorctched as ourselves." It is remarkable 
that these mad people, who had destroyed their only child, should write to a 
friend, to commend to his care their dog and cat ! 

In 1770, a young citizen of Lyons, handsome, having a fine figure, amiable, 
and possessed of superior talents, becomes enamored of a young lady, whose 
parents are unwilling to betroth to him. Her lover ruptures a blood vessel in 
making some undue effort ; the physicians declare that no hope of recovery 
remains, and his mistress provides him a temporary abode. She is armed 
with two pistols and as many poniards. They embrace for the last time, — the 
triggers of the two pistols are attached to ribbons. The lover holds that 
which is to kill his mistress, while the latter holds the ribbon of the pistol 
which is to take the life of her lover. Both pull at a given signal, and both 
fall at the same instant. This example having become but too celebrated, 
has had, unhappily, many imitators. 

Some years since, the son of a justice of the peace, employed in one of the 
bureaux of the Legion of Honor, became attached to a young lady, the daugh- 
ter of a wealthy merchant. The parents of the latter refuse their consent to 
the marriage, on account of the youth of the suitor. They repair to the 
forest of St. Germain ; where the lover, having blown out the brains of his 
mistress who had not the courage to destroy herself, suspends himself from a 
tree by the shawl of her Avho had just consented to die for him, and by his 
hand. 

Madame de Stael, who, during the excitement of youth, seemed to approve 
of suicide, condemned it at a later period, and reproached herself for this 
error. In an essay, or fragment on suicide, which this celebrated woman at- 
tributes to the pain of living, we read the following example: In 1811, M. 
and Mad'e left their residence and went to the inn at Postdam. After having 
sung pieces suited to the occasion, M. blew out the brains of Mad'e, and 
destroyed himself immediately after. The lady had a father, husband, and 
one daughter; while the gentleman was an esteemed scholar and a distinguish- 
ed officer. 

A disposition to suicide is sometimes feigned ; or, to speak more correctly, 
there are individuals who threaten to take their own lives, without the least 
intention to do so. We sometimes notice this in society, among a class of 
people whose imperious desires lead them to utter all sorts of menaces, in 
order to overcome the resistance which is opposed to their wishes. The in- 
sane, and more particularly monomaniacs, animated by various motives ; now, 
to obtain what they desire ; now, to afflict their friends ; and now, from ca- 

35 



274 SUICIDE. 

price ; pretend to desire to commit self-murder. They